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Introducing Lipitor 

in a smaller size 

Same Lipitor. 

Same cardiovascular benefits. 1 

Previous New 
80 mg pack + 80 mg pack 1 

Lipitor is now available in a smaller size. The size and 
shape of the tablets are new, and the cardiovascular 
benefits 1 remain the same. The 80 mg pack in 
particular is much smaller. 

Reassure your patients that their treatment will offer 
the same cardiovascular risk reduction 1 as always. 


10 mg 







a (13 

- £ 

J < 


40 mg 



♦Not actual size. 

80 mg 



*Actual size. 



Abbreviated prescribing information: Lipitor® 
Presentation: Lipitor is supplied as film-coated tablets containing 
1 0mg, 20mg, 40mg or 80mg of atorvastatin. 
Indications: In patients unresponsive to diet and other non- 
pharmacological measures, Lipitor is indicated for the reduction 
of elevated total cholesterol, LDL-cholesterol, apolipoprotein 
B, and triglycerides in adults and children aged 10 years and 
older with primary hypercholesterolaemia, heterozygous familial 
hypercholesterolaemia or combined (mixed) hyperlipidaemia. Lipitor 
also raises HDL-cholesterol and lowers the LDL/HDL and total 
cholesterol/HDL ratios. Lipitor is also indicated for the reduction of 
>: ■ elevated total cholesterol, LDL-cholesterol, and apolipoprotein B in 
patients with homozygous familial hypercholesterolaemia. Lipitor is 
indicated for reducing the risk of cardiovascular events in patients with 
Type II diabetes and one additional risk factor, without clinically evident 
coronary heart disease, irrespective of whether cholesterol is raised. 
Dosage: The usual starting dose is one Lipitor 10mg tablet daily. 
v Doses should be individualised according to baseline LDL-C levels, 
the goal of therapy, and patient response. Doses may be given at 
' any time of the day with or without food. The maximum daily dose 
1 is 80mg; For patients taking drugs that increase plasma exposure 
f '' to atorvastatin ttie, starting dose should not exceed 10 mg and 
• ' maximum dose of iess than 80 mg may have to be considered. 
. , : . Doses above;20mg/day have not been investigated in patients aged 
I ! <1 8 years, in primary prevention trials, the, dose was 10mg/day. 
£fc Contraindications: Hypersensitivity to any of the ingredients, active 
fc^ivef disease, unexplained elevations, in serum transaminases, 
lll^e^nancy and breast-feeding and In women of child-bearing 
M potential not using contraception 

Warning and precautions: Liver function 
tests should do performed before initiation and 
1 Giwb periodically thereafter and in patients who show 
Ki'PpJli^ signs and symptoms of liver injury (mqnitor raised 

transaminases until they return to normal). Drug dosage should 
be reduced or therapy discontinued if persistent elevations occur 
above 3-times the upper limit of normal. Lipitor should be used with 
caution in patients with a history of liver disease and/or alcoholism. 
For patients with prior haemorrhagic stroke or lacunar infarct, the 
balance of risks and benefits of atorvastatin 80 mg is uncertain 
and the potential risk of haemorrhagic stroke should be carefully 
considered before initiating treatment. Patients with signs and 
symptoms of myopathy should have their creatine phosphokinase 
(CPK) levels monitored. Lipitor should be discontinued if CPK levels 
are markedly or persistently raised or myopathy is diagnosed or 
suspected. Lipitor should be prescribed with caution in patients with 
pre-disposing factors for rhabdomyolysis. Risk of myopathy may 
increase when administered with certain medications that increase 
the plasma concentration of atorvastatin. If co-administration is 
required a dose reduction or if not practical a temporary suspension 
should be considered; the starting dose of atorvastatin should be 
10 mg. In the case of ciclosporin, clarithromycin and itraconazole a 
lower maximum dose should be used. Although interaction studies 
with atorvastatin and fusidic acid have not been conducted, severe 
muscle problems such as rhabdomyolysis have been reported 
in post-marketing experience with this combination - therefore 
patients should be closely monitored and temporary suspension of 
atorvastatin treatment may be appropriate. As with other statins, 
rhabdomyolysis with acute renal failure has been reported. A 
history of renal impairment may be a risk factor for rhabdomyolysis. 
Exceptional cases of interstitial lung disease have .been reported 
with some statins and statin therapy should be discontinued if a 
patient is suspected to have developed interstitial lung disease. 
Patients with galactose intolerance, Lapp lactase deficiency or 
glucose-galactose malabsorption should not take this product. 
Pregnancy and lactation: Lipitor is contraindicated in pregnancy 
and lactation. 

Side effects: Side effects most frequently reported in controlled 
clinical studies: nasopharyngitis, hyperglycaemia, pharyngolaryngeal 
pain, epistaxis, constipation, flatulence, dyspepsia, abdominal 
pain, headache, nausea, arthralgia, myalgia, pain in extremity, 
musculoskeletal pain, muscle spasms, joint swelling, asthenia, 
diarrhoea, insomnia, abnormal liver function tests, elevations in ALT 
and CPK levels. Other side effects have been reported in clinical 
trials and post-marketing (See Summary of Product Characteristics). 
Legal category: POM. 
Date of Revision: December 2009 

Package quantities, marketing authorisation numbers and 
basic NHS price: Lipitor 10mg (28 tablets), PL1 6051/0001 £13.00, 
Lipitor 20mg (28 tablets), PL1 6051/0002 £24.64, Lipitor 40mg 
(28 tablets) PL1 6051/0003 £24.64, Lipitor 80mg (28 tablets) PL 
16051/0005 £28.21. 

Marketing Authorisation Holder: Pfizer Ireland Pharmaceuticals, 
Pottery Road, Dun Laoghaire, Co. Dublin, Ireland. 
Lipitor is a registered trade mark. 

Further information is available on request from: Medical 
Information, Pfizer Limited, Walton Oaks, Dorking Road, Tadworth, 
Surrey KT20 7NS. 
Ref: LR12J. 

Reference: 1 . Colhoun HM et at. Lancet 2004; 364: 685-696. 

Adverse events should be reported. Reporting forms and 

information can be found at 
Adverse events should also be reported to Pfizer Medical 
Information on 01304 616161. 

Date of preparation: March 201 0. Item code: UP3279. 

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Red tape to the coalition government 
is like a red rag to a bull. Cameron, 
Clegg and co want to cut PCT admin 
costs by a third and ditch health 
quangos according to their NHS 
vision. Their reaction to the latest 
efforts to solve stock shortages 
might therefore make for interesting 
viewing (p4). 

A Department of Health (DH) 
led steering group has met with 
manufacturers whose medicines are 
reported on an official shortages list 
(p4). At first sight this appears a 
sensible move. There are many sides 
to the stocks saga and getting the 
manufacturers together to agree an 
effective resolution is crucial. 

The trouble is the DH didn't. 
Separate meetings have been set 
with each firm, which is an 
unnecessary duplication of resources. 
Civil servants have racked up over a 
dozen meetings - that's a lot of 
biscuits that could have been 
trimmed from public sector 

The format also seems counter 
productive. Moves to solve stock 
shortages have been about setting 
aside individualism for the greater 
good. Bringing manufacturers into 
the same room would have 
reinforced this ethic. 

Obviously there are practical 
issues - you'd need a big table to 
host the numerous representatives 
affiliated to more than a dozen 
manufacturers and the parties that 
make up the steering group. 

But, you could break the sessions 

down into smaller focus groups to 
target specific actions. That would 
give manufacturers the opportunity 
to exchange views on the UK supply 
chain. Swapping experiences with 
contemporaries is a great way to 
spark ideas and fresh thinking is just 
what we need to solve shortages. 

Sure these firms are fierce rivals, 
but that shouldn't get in the way. 
Just look at wholesaling - an area of 
the supply chain also subject to 
some bitter competition. At last 
year's C+D Conference, the heads of 
the two biggest players, AAH and 
Alliance Healthcare, united to tackle 
stock shortages. 

It's an example of the open 
approach we need. The final action 
point from the previous stock summit 
in March highlights the importance 
of exchanging information to avoid 
shortages. Strange then that a series 
of talks on the matter should 
employ confidentiality clauses to 
keep things under wraps. 

Amid this culture of secrecy, it's 
quite difficult to grasp whether stock 
shortages have got any better. C+D 
has brought back its Stock Survey - 
first published a year ago - to shed 
light on matters. We plan to 
benchmark the findings against our 
2009 data. For the results to carry 
weight, we need as many of you as 
possible to fill in and return the 
survey on p12. 

It's up to us to kick off the spirit of 
collaborative working that could 
finally end the stock shortages saga. 
Max Cosney, News Editor 

» »'* East 

4 Stock measures imminent 

5 RPSGB disciplinary delays under fire 

6 Sector poised for flu jab contract 
8 Pharmacist kept off register 

10 Mentholatum UK - products and plans 
12 Stock shortages survey - win an iPod 

14 Letters - Mark James and Mimi Lau 

15 Xrayser and David Reissner 
26 Classified 

30 Postscript - charity summer bonanza 

16 Update: Managing rheumatoid arthritis 

How treatment limits disease progression 

20 Practical Approach 

How do you recognise cannabis addiction? 

22 Weight management 

Two pharmacies - two approaches to losing weight 

25 Jobs 

Your rights when you're ill 

UBM Medica, Chemist+Druggist incorporating Retail Chemist, Pharmacy Update and Beauty Counter Published Saturdays by UBM Medica, Ludgate House. 245 Blackfriars Road, London SE1 9UY C+D online at: Subscriptions: With C + D Monthly pncelist £250 (UK), without pricelist £205 (UK) ROW price £365 Circulation and subscription UBM Information Ltd, Tower House. Sovereign Park, Lathkill St, 
Market Harborough, Leics. LE16 9EF. Telephone: 01858 438809 Fax: 01858 434958. Refunds on cancelled subscriptions will only be provided at the publisher's discretion, unless specifically guaranteed within the terms of 
subscription offer. The editorial photos used are courtesy of the suppliers whose products they feature We are not responsible for the content of any external websites referred to in this magazine All rights reserved No part of 
this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including photocopying, recording or any information storage or retrieval system without the express prior written consent 
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Press, Queens Road, Ashford TN24 8HH. Registered at the Post Office as a Newspaper Volume 274 No 6755 

10.07.10 Chemist Druggist 3 


Stock measures imminent as 
secret supply talks revealed 

EXCLUSIVE Clamp-down on parallel trading to feature in measures to guarantee medicine stocks 

Max Gosney 


The government is set to publish a 
raft of measures to combat stock 
shortages after secret talks with 
manufacturers who have been linked 
to supply problems. 

Companies whose medicines 
feature on an official PSNC 
shortages list have been called to 
discussions at the Department of 
Health (DH), C+D can exclusively 

Pharma firms have been quizzed 
by a cross-party medicines supply 
chain group set up to implement the 
findings of a ministerial stock 
summit in March. 

The talks between pharmacy, DH, 
wholesaler and manufacturer 
representatives were subject to a 
confidentiality agreement. However, 
meeting insiders have leaked key 
details to C+D this week. 

Talks have centred on establishing 
a tougher code of conduct to stop 
stakeholders manipulating medicine 
supply, sources revealed. 

A clampdown on pharmacists who 
breach their ethical duty to patients 
by parallel trading is being 
investigated, one said. 

A meeting attendee told 
C+D: "We're having a conversation 
in terms of understanding the issues 
and sharing best practice to address 

Another insider added: "The idea 
is to move to the agreed outcomes 
of the stock summit earlier this 
year. . . I think it's fair to say that 
there will be an update on the 
outcomes in the next few weeks." 

horizon under DH plans 

1. Tougher code of conduct on 
medicine supply: pharmacists 
face rap from representative 
bodies for abusing supply. 
Manufacturers, wholesalers 
stripped of licences and 
prosecuted for breaching code. 

2. MHRA-led programme of 

3. A centrally held list of 
medicines in short supply. 

4. Buffer stocks to be held by 
select wholesalers as 
protection against shortages. 

5. Regular meetings with 
supply chain to assess 
shortage problems. 

from DH stock summit, March 2010 

Manufacturers whose medicines 
feature on the PSNC shortage list 
are involved in the talks, the source 
revealed. There are currently 16 firms 
on the list. 

Each manufacturer will hold a 
separate meeting with the group 
rather than a discussion between 
all parties, the source revealed. This 
is partly due to commercial 
sensitivities, one manufacturer 
told C+D. 

A meeting source said he did not 

believe the fragmented nature of 
discussions would hinder progress as 
each manufacturer operated a 
different medicine supply model. 

The ABPI said it was working with 
all parties to ensure UK patients 
continue to receive their medicines. 

The DH said all the parties in 
the supply chain had continued to 
work together and the talks had 
"made good progress" in agreeing 
measures set out at the stock 
summit in March. 

Supply standards 

The government should decide 
on acceptable standards for 
supplying medicines to patients 
in a timely manner, experts 
have said. 

Martin Sawer, executive 
director of the British 
Association of Pharmaceutical 
Wholesalers (BAPW), told C+D 
that industry stakeholders at the 
BAPW's annual conference felt 
there needed to be standards on 
what patients and the NHS 
wanted from the supply chain. 
"What is timely for patients? 
Emergency deliveries come the 
next day, but is that what 
pharmacists and patients are 
going to have to put up with?" 

Mr Sawer said that when 
standards had been set, the 
supply chain could work towards 
meeting them. 

He added that stock shortages 
seemed to have improved in the 
first three months of 2010 but 
were worsening again. "It has 
started to slip again... 
pharmacists are having to spend 
more and more time trying to 
source stocks." ZS 

Complete our Stock 
Survey and you could 
win an iPod Shuffle 

See p12 for the survey 

MP quizzes Lansley on shortages 

Adrian Sanders: acted in response to 
complaints from pharmacy groups 

An MP has highlighted the impact of 
stock shortages to the health 
secretary Andrew Lansley. 

Adrian Sanders MP submitted a 
written question that asked how 
many patients had to wait more 
than 48 hours for their prescriptions 
to be dispensed. 

TheTorbay MP said that as chair 
of the all-party diabetes group he 
had been made aware of stock 
shortages of certain medicines. 

Constituents and pharmacy 
groups had also written to him 
complaining about medicine 
shortages, he told C+D. 

Mr Sanders said: "It seems to 
stem from companies being able to 
trade across international 

"It stopped briefly as the pound 
was weak but as the pound gets 
stronger against the Euro the trade 
may start again." 

He added: "There is still the 
possibility shortages will continue." 

The MP submitted further 
questions to the health secretary 
asking what cost savings could be 
attributed to parallel trading. 

Simon Burns MP responded to th< 
question and said: "The Departmenl 
continues to work collaboratively 
with supply chain organisations to 
explore further measures to help 
alleviate the situation." HF 


Complete the Stock Survey online 


RPSGB under fire over 
delays to disciplinaries 

Pharmacists made to wait over five years for initial hearings 

Zoe Smeaton 

Over 130 pharmacists are still 
waiting for an initial hearing from 
the RPSCB's disciplinary committee 
concerning allegations about their 
practice. And some have had the 
accusations hanging over them for 
over five years, experts warned 

The figures come despite moves 
by the Society to reduce the number 
of pharmacists being referred to its 
statutory committees. 

A statistical report by the RPSGB 
shows that between January and 
April this year, 42 cases were heard by 
the disciplinary committee and 89 
by the investigating committee. Of 
the latter, 12 per cent were referred 
to the disciplinary committee, 17 per 
cent were dismissed or no action was 
taken and 53 per cent were dealt 
with by letter of advice or warning. 

Of the cases where no further 
action was needed, 38 per cent 

C+D shows off 
London's best 

C+D will be touring pharmacies 
across London this month to raise 
awareness of innovative public 
health services - and we want to put 
your pharmacy on the map. 

A National Audit Office report 
found London "makes more use of 
pharmacies" for health interventions 
than other areas. 

From July 26-30, our team will 
visit pharmacies in a range of PCTs, 
each offering a different enhanced 
service. We will interview the 
pharmacist about the difference the 
service has made. The results will be 
delivered to the mayor of London 
Boris Johnson. CC 

To get involved and have the C+D 
team visit your pharmacy, email 

referred to allegations of failure to 
adhere to professional or legal 
standards of practice and 24 per 
cent to dispensing errors. 

The Society also reported that 
since November 2007, 407 fewer 
cases of single dispensing errors 
were referred to the investigating 
committee. But it said 188 
pharmacists were awaiting hearings 
by the disciplinary, health and 
registrations appeals committees, 
with 134 still waiting for a principle 
hearing with the disciplinary 

Noel Wardle, a solicitor with 
Charles Russell LLP, agreed more 
cases were being dealt with by 
warning letter where pharmacists 
admitted to the allegations. But he 
said the improvements were having 
no effect on the time being taken to 
hear disciplinary committee cases. 

One case referring to an incident 
in 2005 had still not been heard, he 
said. "That's not unusual and there 

Stat Comm figures 

Cases awaiting principle hearing 
by disciplinary committee 

Complaints under investigation 

Committee cases dealt with by 
letter of advice or warning 

Source: RPSGB Council papers, June 2010 

does seem to be some inefficiency in 
the system," he warned. He added 
that delays were in nobody's interest 
and increased costs for everybody. 

The Society said it was "working 
very hard" to ensure that the list of 
cases transferred to the CPhC when 
it takes over regulatory powers was 
the minimum number possible 

Government urged to 
outline future plans 

The new government must outline 
its plans for community pharmacy 
with urgency and must not overlook 
the sector, the NPA has warned. 

Following the association's latest 
board meeting, chairman Ian Facer 
told C+D: "Our concern is that, as 
you would expect with a new health 
secretary coming in with their own 
thoughts and ideas, they will be 
looking to introduce new strategies." 

He said the government needed 
to outline any such thoughts on 
pharmacy quickly, warning that 
contractors who had invested in 
premises and staff to offer new 
services had been left not knowing 
whether the benefits of that would 
be realised. 

The NPA had written to Andrew 
Lansley and pharmacy minister Earl 
Howe, Mr Facer said, to stress the 
urgency of developing community 
pharmacy. He said the association 
hoped to have a meeting with Earl 
Howe towards the end of summer 
and would tell him how community 

Ian Facer: contractors who have 
invested heavily need assurances fast 

pharmacy could help to reduce 
waste in the NHS and work to 
improve public health. 

"What we want as soon as 
possible is the opportunity to shape 
the policy," he said. 

The Department of Health 
confirmed it was still reviewing the 
pharmacy white paper against its 
own health priorities. ZS 

Sinemet campaign 

A Parkinson's charity has called for 
action on global shortages of 
Parkinson's drug Sinemet. 
Parkinson's UK is demanding that 
manufacturer Merck takes more 
responsibility for communicating 
about supply issues. 

CIP payment checks 

The NHS Business Services 
Authority has confirmed it is now 
collating requests from contractors 
to check CIP payments to the end 
of March 2009. The authority will 
discuss the information received 
with the DH before determining 
the next steps in the process. 

Victorian Pharmacist 

The Victorian Pharmacist will 
make his TV debut on Thursday at 
9pm on BBC2. The show, titled 
The Victorian Pharmacy, stars 
RPSCB vice-president Nick Barber. 
The show looks at medicines and 
cures from the 19th century. To 
review the show for C+D, email 

NCSO update 

The DH and National Assembly 
for Wales have agreed to allow 
NCSO endorsements for 
nizatidine 300mg capsules for July 

SCC lobbies Lansley 

The Self Care Campaign has 
requested a meeting with health 
secretary Andrew Lansley to 
highlight how self-treatment can 
cut NHS spending. It estimates 
£2bn could be saved by increasing 
self-management of conditions. 

Commissioning awards 

Entries are now open for the Acorn 
Awards 2010, which will honour 
PCTs excelling at commissioning 
pharmacy services. Judges include 
PSNC chief executive Sue Sharpe 
and DH community pharmacy 
tsar Jonathan Mason. 

Survey winner 

Congratulations to Jatinder Rai, of 
Lloydspharmacy Sunningdale, 
who was randomly selected from 
respondents to C+D's swine flu 
survey and wins an iPod Shuffle. 



Check out C+D's clinical archive 

Sector poised for flu 
jab 'sleeping contract' 

Negotiations set to start for pharmacy pandemic-vaccination deal 

Chris Chapman 

Negotiations for pharmacists to 
provide vaccinations in the event of 
an influenza pandemic are poised to 
start, the Department of Health 
(DH) has revealed. 

The news comes as a C+D 
survey reveals more than half of 
pharmacists want a national plan in 
place for pharmacy to improve the 
sector's response to future 

The negotiations follow 
recommendations in an independent 
review of the UK's response to last 
year's H1N1 pandemic by former 

chief medical officer of Wales 
Deirdre Hine, published last week. 

In her report, Dame Deirdre 
suggested a "sleeping contract" for 
any emergency vaccination 
programme, agreed in advance "with 
CPs or willing providers such as 
community pharmacists" and to be 
activated in a pandemic. 

"A sleeping contract would allow 
difficult negotiations to be 
undertaken in a more reasonable 
timeframe than is possible during a 
pandemic," Dame Deirdre said. 

"I understand that preliminary 
discussions on such a sleeping 
contract are already taking place," 
she added. 

Both the DH and PSNC head of 
pharmacy practice Barbara Parsons 
confirmed that the possibility of a 
sleeping contract for pharmacy had 
been raised. 

The independent report comes 
as a C+D straw poll of 43 readers 
found eight out of 10 pharmacists 
feel the UK's response to the swine 
flu pandemic was well organised, 
with good information from PCTs 
and LPCs. 

However, more than 50 per cent 
felt a national response plan to 
pandemics would have improved the 
sectors response to swine flu, with 
one in three calling for improved 
communication to the sector. 

Clinical debate C+D's Chris Chapman looks at the evidence behind the headlines 

Rich-poor gap hints at new role 

Diabetes doubts rife 

More than three quarters of 
pharmacists do not feel they know 
enough about newer treatments 
for diabetes to perform MURs, a 
survey has revealed. Only 4 per 
cent and 2 per cent felt they had a 
thorough understanding of DPP-4 
inhibitors and GLP-1 analogues 
respectively, a survey of 200 
pharmacists found. 

Supeindlrag Ift&imi profit 
Financial reports for Superdrug, 
filed this week, show an operating 
profit for 2009 of £6 million 
compared with an operating loss 
for 2008 of £2.4m.The 
improvement follows cost savings, 
improved margins and tightened 
control of slow-moving stocks. 

Ryder cup bad 1 

Independent pharmacy support 
group Cambrian Alliance has been 
contracted to manage the on-site 
pharmacy at the Ryder Cup at 
Newport in October. Cambrian is 
to work with the golf event 
organisers to build, stock and 
manage a facility at the event. 

Servier supply deal 

Servier Laboratories is to restrict 
distribution of its products to just 
three wholesalers - Alliance 
Healthcare, Phoenix Healthcare 
and AAH Pharmaceuticals. The 
new supply chain arrangements 
will be in place from August 1. 

Co-op gets ethical 

The Co-operative Pharmacy 
has launched an ethical strategy 
that the group claims will 
reinforce the organisation's 
commitment to responsible 
retailing, combating climate 
change and caring for 
communities. The strategy will 
include a three-year partnership 
with children's charity UNICEF. 

Healthcheck events 

Pharmacist Bobby Mehta, founder 
of the Sunday Morning Soccer 
service, is to run local healthcheck 
days at community events in an 
area just west of London. BMI, 
blood pressure and diabetes 
checks will be offered. 

More on all these stories at 

Last week, the nationals revelled in 
old cliches about the health 
differences between rich and poor 
after the National Audit Office 
(NAO) exposed a gulf in patient 

Reading between the lines of 
the report, it could be the 
government intends for pharmacy 
to play a substantial role in the 
solution to this public health 

According to the report, the 
health disparities are across the 
board. When compared with 
affluent patients, those from 
deprived backgrounds are more 
likely to smoke (smoking rates are 

169 per cent higher) be obese (22 
per cent higher), have type 2 
diabetes (77 per cent higher) and be 
at high risk of cardiovascular disease 
(22 per cent higher). Even medicines 
prescribing suffers: 21 per cent of 
those better off with CVD are on a 
statin, compared with 19 per cent for 
deprived patients. 

What's being done? The report 
says nobody really knows. "PCTs are 
not allocated funding specifically to 
tackle health inequalities," the NAO 
states, "but are required to address 
health inequalities from within their 
general funding allocations." 

While PCTs in spearhead areas (ie 
most deprived) get roughly an extra 
£230 per head to deal with health 
problems, the report adds: "There is 
evidence that some of the extra 
money has been absorbed by 
funding higher hospital costs in 
deprived areas." 

The silver lining to this cloud is 
that it's another opportunity for 
pharmacy to step up to the plate. 

Smoking cessation, CVD checks 
and independent prescribing could 
all make a difference to these 
statistics, especially with the advent 

of Healthy Living Pharmacies. 

But perhaps the best news for 
pharmacy is contained in the 
report's recommendations. 
According to the NAO, in the 
future there needs to be the 
implementation of proven, cost- 
effective services, targeted 
specifically at those who need 
them; publicly available 
information on commissioning 
results; costed proposals for 
increasing investment in tackling 
conditions such as CVD; and 
practical guidance on how to 
overcome barriers to reaching 
these hard to target patient 

Is it just me, or is the report 
talking about pharmaceutical 
needs assessments? 

To discuss this subject in 
private with your pharmacy 
colleagues, join the debate in 
C+D's Linkedin group at - search for 
Chemist and Druggist. 

Chat with Chris on Twitter: 

now you can swap 

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and those around them. It is indicated in pregnant and lactating 
women making a quit attempt. Dosage: Adults and Children over 
12 years of age: Nicorette Inhalator should be used whenever the 
urge to smoke is felt or to prevent cravings in situations where 
these are likely to occur. Smokers willing or able to stop smoking 
immediately should initially replace all their cigarettes with the 
Inhalator and as soon as they are able, reduce the number of 

cartridges used until they have stopped completely. Smokers 
aiming to reduce cigarettes should use the Inhalator, as needed, 
between smoking episodes to prolong smoke-free intervals and 
with the intention to reduce smoking as much as possible. As soon as 
they are ready smokers should aim to quit smoking completely. When 
making a quit attempt behavioural therapy, advice and support 
will normally improve the success rate. Those who have quit 
smoking, but are having difficulty discontinuing their Inhalator 
are recommended to contact their pharmacist or doctor 
for advice. Contraindications: Children under 12 years and 
Hypersensitivity. Precautions: Unstable cardiovascular disease, 
diabetes mellitus, G.I disease, uncontrolled hyperthyroidism, 
phaeochromocytoma, hepatic or renal impairment, chronic throat 
disease, obstructive lung disease or bronchospastic disease. Stopping 

smoking may alter the metabolism of certain drugs Transferred 
dependence is rare and both less harmful and easier to break than 
smoking dependence. May enhance the haemodynamic effects of, 
and pain response to, adenosine. Keep out of reach and sight of 
children and dispose of with care. Best used at room temperature 
Pregnancy & lactation: Only after consulting a healthcare 
professional Side effects: Cough, irritation of throat and mouth, 
headache, nasal congestion, nausea, vomiting, hiccups, 
palpitations, Gl discomfort, dizziness, reversible atrial fibrillation 
See SPC for further details. RRP (ex VAT): 6-Starter pack £6.99, 
42-Refill pack £21.99 Legal category: GSL. PL holder: McNeil 
Products Ltd, Roxborough Way. Maidenhead, Berkshire, SL6 3UG 
PL number: 1 551 3/01 79 Date of preparation: March 201 
Date of preparation: May 201 05761 


For daily breaking news 


Will you accept the 
swine flu jab? 

"I have had the swine flu vaccine 

because every day I deal with elderly 

customers and young children, and 

we work next to a health centre so I 

am in the frontline." 

Julie Key, Murrays Healthcare, 


"I would not have it because at the 
moment there is no evidence that 
the swine flu strain is virulent, so I 
would rather catch the virus and 
develop natural immunity as I am 
not in an at-risk group." 
Elaine Stevenson, Medipharmacy, 

Web verdict 

Yes - it's important to take up 
this right 39% 

No - I'll take my chances 61% 

Armchair view: There is no 
consensus from pharmacists on the 
swine flu vaccine, with 61 per cent of 
respondents saying they are happy 
to take their chances with the virus. 
On the other hand nearly two in five 
think it is important to get the same 
protection as other frontline staff. 

Next week's question: 

Did you take any time off work to 

watch the World Cup? Vote at 

Pharmacist guilty of 
fraud kept off register 

Public confidence could be damaged, says committee chairman 

Max Cosney 

A pharmacist struck off for 
defrauding over £5,000 from the 
NHS has failed in his bid to be 
restored to the register. 

Reinstating John Wesley Gilpin 
would damage public trust in the 
profession, an RPSGB disciplinary 
panel ruled last month. 

Mr Gilpin pocketed between £78 
and more than £700 a month filing 
false prescription claims between 
2000 and 2002 

The fraud took place while Mr 
Gilpin was the manager of a 
pharmacy in Portadown, Northern 
Ireland. He also owned two 
pharmacies in Scotland and filed 
claims with the NHS Scotland 
Practitioner Services for 
prescriptions issued in Northern 

Ireland that had not been dispensed. 

The gravity of his offences ruled 
out a return to practice despite 
Mr Gilpin having nearly served the 
recommended five-year absence 
from the register, the panel said. 

Statutory committee chairman, 
Patrick Milmo QC said: "The 
question we must ask is how will the 
public at large react in terms of 
confidence in the profession if his 
name was now restored. We have 
concerns that public confidence 
would be damaged." 

Mr Gilpin had returned to 
pharmacy, working as a dispenser, 
the panel heard. 

He had repaid the £5,371 he 
pleading guilty to taking in false 
prescription claims and additional 
sums not subject to charges. 

Mr Gilpin had also completed 
a return to practice course, 

the hearing was told. 

He would not represent a danger 
to the public if restored to practice, 
Mr Milmo added. 

But Mr Gilpin was criticised for 
showing "limited insight" into his 
offences. Mr Milmo said: "The best 
he could do was to use phrases 
[such] as 'I cannot explain why I 
acted in this way', and 'there was no 
logical reason for me so acting'." 

Although his restoration bid was 
rejected, Mr Milmo stressed that 
another application could be made 
in 12 months. 

What are your rights 
when you're absent due 
to illness? 

See our guide on p25 

Combined oral contraceptive range launches 



Consilient Health 
has announced 
the launch of a 
range of combined 
oral contraceptive 
brands with 
partner Gedeon 

The companies will be promoting 
these brands to healthcare 
professionals and PCTs over the 
coming months, it says. A website is 
also due to be launched, which will 



GEDARLV 20/150 



contain information for healthcare 

The new range comprises the 
Rigevidon, Gedarel, Millinette and 
TriRegol brands. 

Prices: £1.89/21x3 (Rigevidon); 

£4.93/21x3 (Gedarel 20/ 

150mcg); £5.98/21x3 (Gedarel 

30/150mcg); £4.85/21x3 

(Millinette 20/75mcg); £6.37/ 

21x3 (Millinette 30/75mcg); 

£2.87/21x3 (TriRegol) 

Pip codes: 355-7923; 355-9309; 

355-9275; 355-9267; 355-9259; 


Consilient Health 

Tel: 0208 956 2696 


£1.6m campaign backs Corsodyl mouthwash 

mouthwash is set 
to be the focus of a 
£1.6 million 
campaign this 
summer, GSK 
Healthcare has 

The three-month campaign 
features television, press and 
outdoor advertising. 

The outdoor campaign will break 
in mid-July, with 2,500 posters 

r J | 
rj l 

1 & 
fj U Ljj 




nationwide, says the manufacturer. 

Additional support will come 
from a national press campaign from 
mid-July to the first week of August 
to support Corsodyl Mint 

mouthwash and Corsodyl Daily 
Defence mouthwash, the company 
adds. This will follow a four-week TV 

Prices: £4.69/300ml, 
£9.19/600ml (Mint mouthwash); 
£4.49/500 ml (Daily Defence 
mouthwash); £4.00/75ml (Daily 
gum &. tooth paste) 
Pip codes: 094-8083, 227-7028; 
329-3834; 343-8678 
GSK Consumer Healthcare 
Tel: 0845 762 6637 


-Druggist 10.07.10 

In the UK approximately 10 million adults smoke cigarettes; 1 50% ot 
smokers are not happy with their current smoking habit, of these 12% are 
planning to stop abruptly and 35% are either planning to reduce the amount 
of cigarettes they smoke or reduce the amount they smoke with a view ti > 
stopping alfogethei. However, with no help or support the power of nicotine 
addiction means that few will actually succeed. Research has shown that 
only 3% of smokers will succeed in an unaided quit attempt in any 12-month 
period. ; 

A new way to help smokers quit 

Pharmacists are among the most accessible of all healthcare professionals. Everyday 
almost two million people in the UK visit a community pharmacy for health advice' 1 
making pharmacists ideally placed to provide support to those who are thinking 
of stopping smoking. Nicotine Replacement Therapy (NRT), along with advice and 
support, is an effective and simple way to help smokers reach their ultimate goal of 

The Inhalator is a unique format of NRT which acts as a cigarette replacement 
to help control cravings, with up to one in three smokers remaining abstinent at 
12-weeks. 5 ' 6 ' 78 It is made up of a mouthpiece through which the user draws in nicotine 
by active inhalation. Held like a cigarette, it occupies the hand as well as mimicking 
the hand-to-mouth action. 

As well as controlling cravings, Nicorette 6 Inhalator has been shown to relieve nicotine 
withdrawal symptoms associated with tobacco dependence ', and is indicated: 

To aid smokers wishing to quit 

To aid smokers to reduce the amount of cigarettes they smoke prior to quitting 
° To assist smokers who are unwilling or unable to quit smoking by replacing some 
cigarettes with Nicorette' Inhalator for a safer option to smoking 

The extension of the indication to encompass those unwilling or unable to quit 
smoking means you can provide Nicorette' Inhalator as a safer 
option to smoking when smokers are not yet ready to break 
free from cigarettes. Data suggests that for smokers unable or 
not interested in giving up abruptly, a softer and more gradual 
approach should be considered. Such an approach may produce 
more people wanting to quit. 1 " In fact, one in three of those who 
halve their smoking with Nicorette Inhalator or gum have been 
shown to quit in one year." 


ASH Facts at a Glance - Smoking Statistics; 2010. Available at; 93.pdf Last accessed 19.05.10 
Data on File - IPSOS-UK April 2004 

Fowler G Smoking: Time to confront a mapr health issue, Update Supplement 

2000: 3-7 

Royal Pharmaceutical Society of Great Britain. Community Pharmacy the Untapped Primary Care 
Resource. 2007. 

Available at: Last accessed 25.05.10 
Hjalmarson A, et al. Arch Intern Med. 1997; 157: 1721-172 
Tonnesen R et al. JAMA 1993; 269: 1268-1271 
Schneider NG, et al. Addiction 1996; 91(9): 1293-1306 
Leischow SJ, et al. Am J Health Behav 1996; 20(5): 364-371 

9. Nicorette Inhalator Summary of Product Characteristics 

10. Fagerstrom. Can reduced smoking be a way for smokers not interested in quitting to actually quit? 
Respiration 2005; 72: 216-20 
McNeil products limited data on file - CDTS 001 

Smoking cessation - one step at a time 

Five out of 10 smokers are not happy with then 
current smoking habit.-' So that the support given to 
smokers is well-matched to their individual needs, 
pharmacists should consider the following ways of 
helping their customers: 

• 'Abrupt Quitter' strategy - a smoker who is able to 
stop smoking immediately, often with the help of 
NRT and behavioural support. 

• 'Reduce to Stop' strategy - used to encourage 
those who are not 'abrupt quitters' to build 
towards a quit attempt by gradually reducing the 
number of cigarettes used. 

e 'Safer Option to Smoking' strategy - used 
for those unwilling or unable to quit smoking 
by replacing some cigarettes with Nicorette 
Inhalator, a safer option to smoking for when 
smokers are not yet ready to break free from 

Nicorette Inhalator can now be used in a novel 
way which will help those smokers who 'cannot quit 
yet' to replace some cigarettes, as a safer option to 
smoking. Pharmacists can help patients, who have 
previously felt they cannot quit, take the first step on 
their journey with the end goal - smoking cessation - 
in sight. 

Community pharmacists are encouraged to advise 
on the correct use of nicotine replacement therapy 
(NRT) products and to provide behavioural support 
to aid smoking cessation. 

For further information on the Nicorette Inhalator 

encourage the us 
to all smokers inch 

ts smoking reduction as the 
first step to cessation. Smoking cessation is no 
quitting or not. but instead 

ious process that can 

Stephen Foster, Pharmacist. Kent 

Nicorette Inhalator Product Information: 

Presentation: Inhalation cartridge containing 10mg nicotine for 
oromucosal use via a mouthpiece. Uses: Relieves and/or prevents 
craving and nicotine withdrawal symptoms associated with tobacco 
dependence. It is indicated to aid smokers wishing to quit or reduce prior 
to quitting, to assist smokers who are unwilling or unable to smoke, and 
as a safer alternative to smoking for smokers and those around them. 
It is indicated in pregnant and lactating women making a quit attempt. 
Dosage: Adults and Children over 12 years of age: Nicorette Inhalator 
should be used whenever the urge to smoke is felt or to prevent cravings 
in situations where these are likely to occur. Smokers willing or able 
to stop smoking immediately should initially replace all their cigarettes 
with the Inhalator and as soon as they are able, reduce the number of 
cartridges used until they have stopped completely. Smokers aiming to 
'educe cigarettes should use the Inhalator, as needed, between smoking 
episodes to prolong smoke-free intervals and with the intention to reduce 
smoking as much as possible. As soon as they are ready smokers should 
aim to quit smoking completely. When making a quit attempt behavioural 
therapy, advice and support will normally improve the success rate. 
Those who have quit smoking, but are having difficulty discontinuing 
Iheir Inhalator are recommended to contact their pharmacist or doctor for 
advice Contraindications: Children under 12 years and Hypersensitivity 
Precautions: Unstable cardiovascular disease, diabetes mellitus. G.I 
disease, uncontrolled hyperthyroidism, phaeochromocytoma, hepatic 
renal impairment, chronic throat disease, obstructive lung disease or 
ironchospastic disease Stopping smoking may alter the metabolism 
f certain drugs Transferred dependence is rare and both less harmful 
snd easier to break than smoking dependence. May enhance the 
laemodynamir, effects of. and pain response to. adenosine. Keep out of 

reach and sight of children and dispose of with care Best used at room 
temperature Pregnancy & lactation: Only after consulting a healthcare 
professional. Side effects: Cough, irritation of throat and mouth, 
headache, nasal congestion, nausea, vomiting, hiccups, palpitations. 
Gl discomfort, dizziness, reversible atrial fibrillation. See SPC for further 
details. RRP (ex VAT): 6-Starter pack £6.64, 42-Refill pack £20.89. Legal 
category: GSL PL holder: McNeil Products Ltd. Roxborough Way, 
Maidenhead. Berkshire. SL6 3UG PL number: 15513/0179. Date of 
preparation: March 2010 

Nicorette Gum Product Information 

Presentation: Nicorette 4mg gum and Nicorette 2mg gum contain 4mg 
and 2mg of nicotine respectively in a chewing gum base. Original, Mint. 
Freshmmt. Freshfruit and Icy White flavours. Uses: Relief of nicotine 
withdrawal symptoms as an aid to smoking cessation Used to help 
smokers ready to stop smoking immediately and also smokers who need 
to cut down their cigarette use before stopping. Dosage: Adults (over 18 
years): No more than 15 pieces of gum should be used each day. Use 
when there is an urge to smoke. Patients smoking 20 or less a day should 
use 2mg gum. Those smoking more than 20 should use 4mg gum. Each 
piece should be chewed slowly for about 30 minutes. Smoking cessation: 
Patients should stop smoking during treatment. After up to 3 months ad 
libitum dosage, Nicorette gum use should be gradually reduced. Those 
who use NRT beyond 9 months should consult a healthcare professional 
Smoking reduction: Use the gum between smoking episodes to reduce 
smoking. A quit attempt should be made as soon as the smoker feels 
ready but no later than 6 months. Professional advice should be sought if 
no reduction in 6 weeks or no guit attempt in 9 months. Adolescents (12 

to 18 years): No more than 15 pieces of gum should be used each day. 
Smoking cessation: After 8 weeks ad libitum dosage, reduce gum use over 
4 weeks. If not stopped by 12 weeks, a healthcare professional should 
be consulted. Smoking reduction: Only after consulting a healthcare 
professional. Under 12 years: Not recommended Contraindications: 
Hypersensitivity Precautions: Denture wearers. Gl disease, unstable 
cardiovascular disease, diabetes mellitus. uncontrolled hyperthyroidism, 
phaeochromocytoma, renal or hepatic impairment. Stopping smoking 
may alter the metabolism of certain drugs. Transferred dependence is 
rare and less harmful and easier to break than smoking dependence. 
May enhance the haemodynamic effects of. and pain response to, 
adenosine. Keep out of reach and sight of children and dispose of 
with care. Pregnancy & lactation: Only after consulting a healthcare 
professional. Side effects: Headache, sore mouth or throat, |aw-muscle 
ache. Gl discomfort, hiccups, nausea, vomiting, dizziness, erythema, 
urticaria, palpitations, allergic reactions, reversible atrial fibrillation. See 
SPC for further details RRP (ex VAT): 2mg gum (10) £2 84, (30) £4.83, 
(105) £13.23. (210) £22 07; 4mg gum (30) £5.94, (105) £16.12. (210) 
£27.16. Icy White 2mg gum (30) £5.08, (105) £13.96; 4mg gum (105) 
£17.0.9 Legal category: GSL. PL numbers: Original 2mg 15513/0169. 
4mg 15513/0170; Mint 2mg 15513/0171. 4mg 15513/0172; Freshmmt 
2mg 15513/0173. 4mg 15513/0174; Freshfruit 2mg 15513/0136. 4mg 
15513/0137; Icy White 2mg 15513/0152; 4mg 15513/0153 PL holder: 
McNeil Products Ltd, Roxborough Way. Maidenhead. Berkshire, SL6 
3UG Date of preparation: March 2010 


Get news delivered straight to your inbox 

Dulcolax name change 

Boehringer Ingelheim has renamed 
two products in its Dulcolax laxative 

Dulcolax Liquid and Dulcolax 
Perles are ^ . ^ 

" Dulcolax 

Pico Perles 

Relief from conslipalio" 

Dulcolax Pico 
Liquid and 
Dulcolax Pico 
from this 

has been 
made to 

highlight that both products contain 
sodium picosulfate, distinguishing 
them from the bisacodyl-containing 
products in the Dulcolax range, says 
the company. 

There has also been a change to 
the licences of the two renamed 
products and they are now indicated 
only for the short-term relief of 
constipation and for the 

management of constipation of any 
cause, according to the company. 

Previously the products were also 
indicated for "bowel clearance 
before surgery, childbirth or 
radiological investigations". 

Prices: £3.25/100ml, £7.75/300ml 
(Dulcolax Pico Liquid}; £2.99/20, 
£4.59/50 (Dylcolax Pico Perles] 
Pip codes: 046-9437, 043-5073; 
303-0889, 276-6566 
Bend iron 

Tel: 01923 208141 

Market focus 

• Constipation affects twice 
as many women as men. 


• Approximately 40 per cent 
of women experience 
constipation during their 


New-look Deep Relief gets 
£1m promotional campaign 

New-look Deep Relief pain-relieving 

gel is set to be the focus of a 

£1 million promotional campaign 

this autumn, Mentholatum has 


will run in 
and will be 
by print 
in trade and 

The campaign will be 
accompanied by an educational 
programme that targets 
pharmacy assistants and medical 

Deep Relief has been repackaged, 
with the new design highlighting 
that the gel contains both ibuprofen 
and levomenthol for two-way pain 
relief, says the manufacturer. 

Prices: £1.00/15g; £3.99/30g; 
£4.99/50g; £9.99/100g 
Pip codes: 214-7205; 244-4818; 
211-4890; 224-6841 


Tel: 01202 780558 

Check out what's on TV 
this week 

Mentholatum's marketing director talks to C+D 

The Mentholatum company has 
come a long way since Albert 
Alexander Hyde developed 
mentholatum ointment to relieve 
pain in the USA in 1889. Marketing 
director Bernice Simpson Diabate 
(pictured) tells C+D about the 
company's products and plans 
following a £10 million investment 
in its manufacturing facility in East 

What are Mentholatum's 
key pharmacy brands? 

There's Deep Relief, Deep Heat and 
Deep Freeze, Regenovex, Bionovex 
oil, the OXY range, and Rohto Dry 
Eye Relief. 

What market share do 
these brands have? 

Mentholatum leads the topical 
analgesics category (all figures IRI, 
52 weeks to April 17, 2010). It has 
three brands - Deep Heat, Deep 
Freeze and Deep Relief - in the top 
10 and has the largest category 
share in the rub, spray and patch 
sub-sectors for both heat and freeze 

Deep Heat is the number one 
topical analgesics brand, growing at 
5 per cent year on year. While the 
rubs sector overall shows a decline 

of 1.9 per cent, Deep Heat bucks the 
trend with growth in all outlets and 
a 60 per cent share of the total 
market. It accounts for 78 per cent 
of value sales in major grocery 
multiples and 52 per cent in the 
pharmacy sector. 

Deep Heat Spray dominates its 
sub-category, with 81 per cent of 
total market share, which equates to 
93 per cent of value sales in major 
grocery multiples and 68 per cent in 

Deep Heat and Deep Freeze 
patches together have 22 per cent 
share of the total market in the 
patch sub-category. 

How are you investing in 
these brands? 

All the above brands have above- 

the-line investment and pharmacy 
support programmes (OXY coming 
soon). Deep Heat, Deep Freeze and 
Deep Relief are supported by TV 
campaigns and consumer and 
trade PR. 

Regenovex has been underpinned 
by consumer press and PR and will 
shortly be supported by a TV 

Response beta will be supported 
by press and PR this year and OXY 
will have both TV and PR support to 
explain the reformulation and 
clinical trial data. 

What product developments 
are in the pipeline? 

We are working on a number of 
products that reflect the ethos of 
innovation in terms of formulations 
and scientific support. Regenovex, 
Rohto Dry Eye Relief and Response 
beta are our most recent launches, 
but there is more exciting news 
to come. 

Is scientific backing 
important in building 
credibility for OTC brands? 

Mentholatum is working with a 
number of Scottish universities to 
both develop new products and also 
test and develop scientific data and 
support for new and existing brands. 
It is committed to developing more 
scientific support for brands such as 
Deep Heat, Deep Freeze and Deep 
Relief, positioning the company as 
experts in muscle and joint care. 

We are also working with a Welsh 
university to generate more support 
data on Rohto Dry Eye Relief and 
there is clinical work being carried 
out in Italy that will be delivered at 
the end of this year to add further 
weight to the brand's efficacy. 

Mentholatum is absolutely 
committed to supporting its 
products with clinical and scientific 
data and there is no doubt that this 
is the cornerstone of OTC brand 

Andrew Tasker, Mentholatum 
MD, talks growth, innnovation 
and your sales opportunities 

10 Chemist +DruP2isi 10.07.10 



Trade op ^our customers to 
Canesten Combination treatments 


The Canesten Combination Rancje 

Trade up 

Pessary to Combi 

["rade up 

Internal Cream to 
Cream Combi 

Trade up 

Oral C apsule to 
Oral & Cream Duo 



C )ral 



action, but customers 
external symptoms too. 

« ----- :•" 

— I 

For more information on the Canesten range please visit the Canesten website at cgyi24 June 2010 


Complete the Stock Survey online at: 

Stock Survey 2010 

Last year our Stock Survey uncovered a sector facing persistent 
medicine shortages and anxious over the impact on patient safety. 
So one year on has the situation improved? Help us to find out by 
completing and returning this questionnaire by August A 

1. On average how long do you 
spend trying to get hold of out of 
stock drugs each week? 

a) Less than an hour O 

b) 1-2hours □ 

c) 2-5 hours □ 

d) 5 hours + O 

2. How many drags are currently 
out of stock at your wholesaler? 

a) □ 

b) 1-5 □ 

c) 5-20 □ 

d) 20-50 1 

e) 50+ □ 

3. Typically how long do you have 
to wait for an emergency stock 
delivery when ordered direct 
from a manufacturer? 

a) 1-2 days □ 

b) 3 days □ 

c) 4-5 days □ 

d) Over 5 days □ 

4. How have you found getting 
hold of branded medicines in the 
past 12 months compared to the 
year before? 

a) No different □ 

b) Easier - there are fewer drugs out 
of stock now than in 2008-09 □ 

c) Harder- there are more drugs out 
of stock than ever before 

5. Has it been easier or harder 
getting hold of product 
from manufacturers running 
reduced wholesaler 
distribution models? 

a) Easier 

b) Harder 

c) Same 



6. Have you ever asked a CP to 
change a prescription be :ause oi 
problems sourcing the drug in 

a) Yes □ 

b) No □ 

7. How concerned are you that 
patients are being adversely 
affected by stock shortages? 

a) Very concerned L~3 

b) Concerns, but not overly worried □ 

c) Not worried O 

8. How many patients have you 
had to turn away because you 
have been unable to source the 
drug they've been prescribed? 

a) □ 

b) 1-5 n 

c) 5-20 □ 

d) 20+ □ 

Win an iPod Shuffle 

Complete the 
survey and be 
entered into a 
draw for a 
chance to 
win an 

9. Have you known a patient 
whose health suffered because 
you were having difficulty 
sourcing a branded drug? 

a) Yes - please provide details □ 

b) No 


10. How would you rate industry 
and government efforts to sort 
shortages in the past 12 months? 

a) Highly effective □ 

b) OK - they've tried hard but with 
limited success 

c) Poor - they haven't done 
enough □ 

11. Over the next 12 months do 
you expect stock shortages to be: 

a) Much worse C} 

b) Slightly worse □ 

c) Stay the same L~J 

d) Slightly better □ 

e) Much better 1 

Your name: 

larmacy name and address: 


Email address: 

Daytime phone number: 

Post this completed page to: Stock Survey, C+D, Ludgate House, 245 Blackfriars Road, London SE1 9UY. 
complete entries will be put into a draw for a chance to win an iPod Shuffle 

By providing your email address, UBM Medica, the publishers 
of C+D, will keep you up to date about our products and 
services for healthcare professionals. Our emails may also 
include information from other carefully selected companies 
including promotional materials from pharmaceutical 
companies that may be of interest to you. Your details WILL 


NOT be passed on to third parties without your consent. If at 
any time you do not wish to receive information from UBM 
Medica, please tick this box. (_J You can view our privacy 
policy at www.chemistanddruggist. 

_| Please tick this box if you are happy for UBMMedica to 

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that wish to provide you with information about products 
and services for healthcare professionals. 

|_J Please tick this box if you would like to receive 
newsletters from Chemist+Druggist. 


Simple. Discreet. Convenient. 

If only everything in life was this un-comp Heated. 


150 micrograms/30 micrograms 
coated tablets M/LL/rvc fte~ 20/75 

TRIREGOL coated tablet 

echinytestradiol / levonorgestrel 

levonorgestrel/ ethinyl 



microgram coated tablets 

fthifiylpstradlol / pt'i!od*'tie 

M/ti/NCTTC - 30/7S 


microgram coated tablets 

uihmyk^liadiol / gcitodeni: 

1 « 21 j Met;. 

GEDAREL* 20/150 

microgram film roared tablets 

GEDAREL 30/150 1 

microgram film-coated tablets 



I PIP Code - Unichem & Phoenix Codes 

AAH code 

1 Product Name and Description 

1 Most Commonly Prescribed UK Brand 1 1 

Blister Pack Size 1 



Rigevidon" Coated Tablets 



Ethinylestradiol 30mcg& Levonorgestrel 150mcg 

(Bayer pic.) 




Gedarel* 20/150 meg Film-coated Tablets 



Ethinylestradiol 20mcg& Desogestrel 150mcg 

(Schering-Plough Ltd.) 




Gedarel" 30/150 meg Film-coated Tablets 



Ethinylestradiol 30mcg& Desogestrel 150mcg 

(Schering-Plough Ltd.) 




Millinette* 20/75 meg Coated Tablets 



Ethinylestradiol 20mcg & Gestodene 75mcg 

(Bayer pic.) 




Millinette*' 30/75 meg Coated Tablets 



Ethinylestradiol 30mcg& Gestodene 75mcg 

(Bayer pic.) 




TriRegol" Coated Tablets 



Ethinylestradiol 30mcg & Levonorgestrel 50mcg 

(Bayer pic.) 


Ethinylestradiol 40mcg& Levonorgestrel 75mcg 

Ethinylestradiol 30mcg& Levonorgestrel 125mcg 

Rigevidon , Gedarel , Mil 

ineue' and TriRegol' at 

1 registered trademarks of Consilient Health Limited and Ged 

•on Richter Pic Reference 1 Data on hie based on 2009 PCA data. 

For further information for healthcare professionals and patients, please visit 

Combined Oral Contraceptive Pills 

Abbreviated Prescribing Information • for full prescribing 
information, including side effects, precautions and contra- 
indications, see Summary of Product Characteristics (SmPC) 

Prescribing Information: Product Name: Rigevidon Coated 
Tablets. Composition: One tablet contains 30 micrograms 
ethinylestradiol and 1 50 micrograms levonorgestrel Gedarel 
30/150 Coated Tablets. Composition: 1 tablet contains 30 
micrograms ethinylesttadiol and 1 50 micrograms desogestrel 
Gedarel 20/1 50 Coated Tablets. Composition: I tablet contains 
20 micrograms ethinylestradiol and 1 50 micrograms desogestrel. 
Millinette 30/75 Coated Tablets. Composition: 1 tablet 
contains 30 micrograms ethinylestradiol and 75 micrograms 
gestodene Millinette 20/75 Coated Tablets. Composition: 
One tablet contains 20 micrograms ethinylestradiol and 75 
micrograms gestodene. TriRegol Coated Tablets. Composition: 
Each pink tablet contains 30 micrograms ethinylestradiol and 
50 micrograms levonorgestrel; each white tablet contains 40 
micrograms ethinylestradiol and 75 micrograms levonorgestrel, 
each ochre tablet contains 30 micrograms ethinylestradiol and 1 25 
micrograms levonorgestrel. Please refer to the Summary of Product 
Characteristics (SmPC) for a full list of excipients Indication: Oral 
contraception Dosage and Administration: One tablet is to be 
taken daily for 21 consecutive days, starting on day 1 of the normal 
cycle Every subsequent pack is started after a 7-day tablet free 
interval, during which time a withdrawal bleed usually occurs. 
Bleeding usually starts on the 2nd or 3rd day after the last tablet and 
may not end before the next pack is started. For details of usage, 
especially where a patient either misses a dose or has vomiting/ 
diarrhoea, please refer to the SmPC 

Contraindications: Combined oral contraceptives (COCs} should 
not be used in the presence or a history of venous or arterial 
thrombosis, including pulmonary embolism and myocardial 
infarction (Ml), previous prodromal symptoms of thrombosis, 
including transient cerebral ischaemia, considerable or multiple 
risk factors for venous or arterial thrombosis or a predisposition to 

either condition (please refer to SmPC), cardiovascular disorders, 
ocular disorders of vascular origin, severe hypertension, diabetes 
complicated with angiopathy, cerebrovascular disordei or 
accident, migraine with focal neurology, pancreatitis with severe 
hypertriglyceridaemia, severe or recent hepatic disorders, liver 
tumours, undiagnosed vaginal bleeding, sex steroid influenced 
malignancies, e g bieast and endometrial, or a hypersensitivity to 
the components of the tablet 

Warnings and Precautions: Pnoi to starting oi resuming use 
a complete history should be taken, a physical examination 
performed and pregnancy ruled out The patient should be 
instructed to carefully read the user leaflet and adhere to the 
advice The benefits of COC use must be weighed against possible 
risks and discussed with the patient with respect to the following 
conditions: venous oi arterial thromboembolism, Ml or transient 
ischaemic attack/stroke Patients who develop an increase in 
frequency or severity of migraine should discontinue COC use A 
possible increased risk of cervical cancer has been repented with 
all long-term COC use Please refer to the SmPC for associated risk 
factors and symptomology associated with the above condition'. 
Breast cancer has been reported in COC users, though no direct 
causation has been shown; clinically lelevant increases in blood 
pressure (rare), hepatic tumours and pancreatitis in the presence 
of or with a family history of hypeitriglycendaemia have also been 
reported. Patients who develop seveie depression during the use of 
COCs should discontinue use and be advised to use an alternative 
contraceptive method until the cause is identified. COCs should also 
be stopped in women with impaired liver Function until tests return 
to normal Please reler to the SmPC for other conditions that have 
been reported with COC usage With all COCs, irregular bleeding 
may occur, especially during the first months of use The evaluation 
of any irregular bleeding should be considered after approximately 
three cycles. If bleeding irregularities occur after previously regulai 
cycles, further diagnostic procedures should be considered Please 
refer to the SmPC for further information regarding cycle control. 

Know your 


Pregnancy and lactation: The COCs die not indicated duung 
pregnancy, treatment should be withdrawn immediately if 
pregnancy occurs The use of COCs is not recommended during 
breasl feeding Effects on ability to drive and use machinery: 

There is no influence on the ability to drive and use machines 
Undesirable effects: The following adverse reactions have been 
reported in women using COCs. Very common (> I/1QI irregular 
bleeding, nausea, weight increase, breast tenderness and headache 
These usually occur at the beginning of treatment and are transient 
Othei common I > 1/100. < 1/WI fluid retention, changes to libido, 
irritability, migraine, acne, amenorrhoea, hypomenorrhoea, 
dysinenorrhoea, metrorrhagia, nervousness, mood changes 
including depression, dizziness, ocular irritation in contact lens 
wearers, visual disturbance, corneal disorders, abdominal pain, 
breast enlargement or secretion, changes in cervical ectropion and 
secietton, vomiting, cholelithiasis and chloasma Venous and arterial 
thromboembolic disorders, cervical cancer, liver tumours and 
chloasma have also been repotted with COC use Please see SmPC 
for other adverse events associated with COC use Overdose: Theie 
have been no reports of serious adverse effects from overdose NHS 
Price: Rigevidon 3x21 tablets £ 1 .89; Gedarel 30/1 50 3 x 2 1 tablets 
£4 93. Gedarel 20/1 50 3 x 2 1 tablets £5 98. Millinette 30/75 3 x 21 
tablets £4.85, Millinette 20/75 3 x 21 tablets £6 37, TriRegol 3x21 
tablets £2.87 

Legal category: All POM Authorisation numbers: Rigevidon 

1 7550/0032, Gedarel 30/1 50 PL 04854/0061 ; Gedarel 20/1 50 PL 
04854/0060 Millinette 30/75 PL 1 7550/0043, Millinette 20/75 PL 
1 7550/0042, TriRegol PL 1 7550/003 1 . Marketing Authorisation 
Holder: Rigevidon, Millinette, TriRegol Medimpex Fiance SA 1 3 
rue Caumartin, 75009 Paris, France Gedarel Gedeon Richter Pic 
1 103 Budapest, Gyomioi ut, 19 21, Hungary Oate of Authorisation: 
Rigevidon October 2007; Gedarel 26.1 1 .2008. Millinette 28.05.2009. 
TiiRegol 20 06.2007 Fuither information is available on request from 
Consilient Health (UK) Ltd, 500 Chiswick High Road, London, W4 
5RG, LIK on 020 8956 2310 

Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to 
Consilient Health (UK) Ltd, 500 Chiswick High Road, London. W4 SRG, UK on 020 8956 2310. 

Available now from Consilient Health and National Wholesalers 

Date of preparation: lune 2010 CH OCs-02 1-06/2010 


What do you think? 

We need a Mary Portas-style shake-up 


Occasionally there are some very odd customers 
through the door. I don't just mean the Mrs 
Malaprops asking for coleslaw lotion or diuretic 
jam, I mean those OTC queries that seem just a bit 
too pat, and you wonder if you've been visited by 
an undercover Which? reporter, or worse - you've 
been 'mystery shopped'. 

It's a while since I worked for a pharmacy 
multiple, so I'd rather forgotten the mystery 
shopper. The best part was looking at their 
comments and trying to work out who they spoke 
to - a blame-game referred to as 'pin the tail on 
the donkey'. Even our PCT got with the 
programme and tried mystery shopping the EHC 
services - the results of this were never released, 
but I understand some pharmacies received 
invitations for additional training... 

Of course no one likes someone checking up on 
them and being put under the spotlight. Surveys 
of shop workers regularly put the mystery shopper 
as one of their greatest fears, and yet patient 
surveys are not seen as something to fear - simply 
a chore - and that alone demonstrates what a 
pointless chore they are. 

When asked "How do you rate us?", patients are 
bound to mark something better than average 
because either they are being polite, or they want 
to get it over and done with, or they fear we will 
have a sneaky look at what they've put. The only 
people who don't are those who are annoyed 
because we're too busy - and then we're too busy 

to ask them to complete a survey anyway. So 
what does the survey tell us? Nothing of use. 

A while ago, an NPA friend asked if I fancied 
having Mary Portas come round. If you are not 
familiar with this lady, you can catch her TV 
programme on Monday nights, where she acts as a 
sort of troubleshooter on high street shops. 
Having been approached by her production 
company for a pharmacy, and realising that a well- 
run, ethical, presentable, go-ahead, professional 
pharmacy wouldn't make good TV, the NPA feared 
the worst - we can all think of somewhere locally 
that would make great TV but we wouldn't want 
to be the national face of pharmacy. 

Yet without a truly critical eye, how do we 
improve? Who is to notice the broken light bulb 
that didn't get fixed? A good area manager once 
told a friend of mine to "get the dead flies out of 
the window, or put a price on them", but we don't 
all have the opportunity to receive such wisdom. 

Perhaps we do need Mary Portas to shake us up, 
not just individually but as a profession. As we 
chase ever more additional services, the most 
common weak point in the patient survey is "lack 
of private, quiet, area for consultation" - even 
when the patient is completing the survey while 
sitting opposite our purpose-built, signposted, 
consultation room! 

How many more perceptions has the 
professional to overcome? Let's hope that won't 
stay a complete mystery. 

Where was RPSGB during Lee prosecution? 

Once an appeal judge gave Elizabeth 
Lee permission to appeal against her 
conviction and sentence, the 
outcome was entirely predictable. 

The Court of Appeal has now 
given its reasons for overturning the 
conviction for a labelling error 
(because the offence could only be 
committed if Mrs Lee was running a 
pharmacy business) and substituting 
a conviction for supplying the wrong 
medication - an offence that did not 
require the defendant to be running 
a pharmacy business. 

There are still loose ends, such as 
the decriminalising of dispensing 
errors. This remains a thorn in the 
side of pharmacists and - don't 
forget - dispensers also can and 
have been prosecuted. 

In my opinion it was inevitable 
that Mrs Lee's suspended sentence 
would be overturned. The Court of 
Appeal was bound to conclude that 
this was manifestly excessive. 

The prosecution had pressed for 
the case to be sent to the Crown 

Court (the Old Bailey is technically a 
Crown Court) and the Court of 
Appeal rightly pointed out that the 
case should normally have been 
dealt with in the Magistrates Court. 

On conviction, the maximum fine 
magistrates could have imposed was 
£5,000. When deciding on the level 
of fine, the Court of Appeal took into 
account the effect on the patient's 
family. That's a perfectly permissible 
consideration these days, though 
personally I think it's important to 
make sure revenge is not allowed to 
feature in our justice system. The 
court took into account Mrs Lee's 
good character and said it would 
have imposed a fine of £400. 

However, because Mrs Lee 
pleaded guilty, the fine was reduced 
to £300. This compares well with 
the fatal Peppermint Water case 
10 years ago, when a pharmacist 
was fined £1,000 and a pre-reg 
student was fined £750, and a 
case in 2009 in which a pharmacist 
was fined £2,065, and a dispensing 

assistant was fined £270. 

There are professional disciplinary 
procedures to deal with dispensing 
errors that might involve 
misconduct, so the CPS should 
not have brought a case that 
merited a fine of only £400. But 
the CPS doesn't deserve all the 
blame. The Royal Pharmaceutical 
Society has always had power to 
prosecute for offences under the 
Medicines Act. 

The Society should have a better 
understanding than the CPS of 
whether a case merits prosecution, 
but the Society stopped bringing 
prosecutions a long time ago. The 
Society's abdication of responsibility 
left a vacuum that the less well- 
informed CPS has filled. 
David Reissner is a specialist in 
pharmacy law and head of 
healthcare at Charles Russell LLP 
Contact him on 0207 203 5065 or 
email david.reissner@ 


14 Chemist Druggist 10.07.10 

More letters online 


Contact us 

• Email your letters, including your name, address and contact 
number, to 

Four months to decide pharmacy's future 

The current government budget 
crisis could be turned from a threat 
facing community pharmacy into an 

The opportunity to influence will 
only exist between now and the 
departmental spending review in 
October: after that influencing how 
and where the health budget is 
spent will become exponentially 
more difficult. 

I suggest four things that need to 
happen urgently. 

Firstly, the bodies that represent 
community pharmacy in England 
need to join forces under a single 
banner with an agreed set of 

Secondly, those bodies need to 
fund a joint professional lobbying 
campaign focused on influencing the 
outcome of the spending review. As 
part of that, there has to be a clear 
focus on influencing treasury 
ministers and officials as ultimately 
they are the ones who decide what 
gets funded and what does not. 

Ironically perhaps, treasury 

ministers and officials may be more 
likely to listen to pharmacy's case 
than their counterparts at the 
Department of Health (DH). 

A critical part of that campaign 
will be to produce a persuasive 
position paper that sets out the 
economic case for community 
pharmacy to play a stronger role in 
providing primary care services. 

Let's just accept that the benefits 
to patients are obvious: the 
argument will be won or lost on 
questions about cost savings and 
getting the same or better patient 
outcomes for less NHS spend. 

There is lots of evidence out there 
- for example the recent 2020health 
think tank report that suggested the 
DH could save £1.6 billion if minor 
ailments were to be commissioned 
through pharmacies - so let's pull all 
the evidence together and present 
the government with a big £ that 
will get their attention. How much 
would the NHS save if it avoided the 
hugely costly secondary care 
interventions that result from 

Mark James: AAH will back united 

medicines non-adherence? 

Thirdly, we need a campaign that 
is not about getting the 'support' of 
MPs: instead it is about getting them 
to act. Unless they are tabling 
questions, writing letters to the 
minister, tabling early day motions, 
or initiating debates then there will 
be no pressure from the Commons 
on health and treasury ministers to 
listen to pharmacy's case. 

Finally, we need an approach that 
does not provoke opposition from 
GPs. Not easy to achieve, but 
necessary nonetheless. 

We need to shift the way people 
think about this debate. Instead of 
putting forward a justification for 
the government to commission 
more services from pharmacy, we 
need a campaign that says - given 
the current budget crisis and the 
pressures facing the NHS - how 
could the government justify not 
commissioning more services from 
community pharmacy. 

If you combine the contacts and 
resources of pharmacy bodies and 
individual companies such as Boots 
and Lloydspharmacy etc, you have a 
strong force, but it needs a shared 
direction and a joint plan of action. 

If such a campaign could be 
launched I assure you we will back it 
with our lobbying contacts and 
resources. I am sure other 
wholesalers would do likewise. 
Mark James, group managing 
director, AAH 

Give us the chance to show you what pharmacy can achieve 

As a result of the budget we are all 
coming to terms with the personal 
and business implications of 
spending cuts and taxation changes. 

We remain uncertain of what the 
coalition government's specific plans 
are for the NHS and how much 
pharmacy will feature. Of course 
there's always the thought that it 
nay mean a heavier workload, but if 
Are are not involved what does that 
;ay about our profession and 
ndustry and sustainability for the 
uture? It's easy to be disheartened 
5ut we should not lose sight of the 
;ood work that pharmacy continues 
:odofor its patients. 

Despite the general doom and 
'loom, I have been inspired by two 
rery recent events, which I was 
ortunate to be part of. 

Firstly, I was involved in selecting 
he best pre-registration student 
raining on the Numark pre- 
egistration programme. Fifty nine 
tudents participated in a health 
iromotion event in their pharmacy 

Mirni Lau: innovative pharmacy 
projects show what the sector can do 

to improve the pharmacy's public 
health remit. As you would probably 
expect, there were some very 
obvious choices in topics such as 
stop smoking, weight management, 
diabetes screening. There is nothing 
wrong with that and it does fit into 
the government's priorities for public 
health. However, what struck me 
was the amount of work that the 

students put in to planning their 
event, marketing, delivering and 
extracting the learnings from it to 
refine their service. 

All these initiatives had the 
wholehearted support of the 
pharmacist tutors as well as the staff 
working in the various pharmacies. 
There were also examples of pure 
innovation, such as the Stamford 
Bridge walk project. This pharmacy 
used a simple but effective 
campaign to increase the activity 
levels of the community through 
organising weekly walks around 
the village. 

Another example was a project 
on smoking cessation whereby the 
pharmacy engaged with Tower 
Hamlet PCT to reach out into the 
transient community. People coming 
out of the nearby tube station were 
targeted and the pre-reg spread the 
message of smoking hazards and 
signposted the pharmacy for advice 
and support on quitting. 
Many of these projects have 

become fully fledged services, which 
is an excellent achievement for the 
students as well as the pharmacy 
team. We have also gone on to share 
the success of these projects 
throughout our organisation so that 
other pharmacies are inspired and 
motivated to do something similar. 

The second event was last 
month's C+D Awards. Seeing so 
much excellence in the work being 
done by individuals, teams and 
businesses is fantastic and proof that 
it's not just the young or newly 
qualified that have great ideas. It 
may often be seen as 'part of our day 
job', but we should celebrate success 
and let our paymasters know the 
worth in investing in pharmacy. 

So ministers, commissioners, if 
you are reading this, please take 
note - don't isolate our profession, 
there is much we offer now to our 
patients and there is still more we 
can offer if you give us the chance. 
Mimi Lau, director of professional 
and training services, Nurr.-in' 

10.07.10 Chemist -Druggi- 15 

mm u wr 





16 Rheumatoid arthritis: pt 2 ^ 20 Cannabis addiction ^ 22 Weight management ^ 25 Sickness rights 

CPD revision guide 

Managing rheumatoid arthritis 

In the second of two articles on rheumatoid arthritis, we reveal how modern 
treatment takes an aggressive approach to limiting disease progression 

Helen Boreham 

Supported by 


Treatment in rheumatoid arthritis (RA) used to be 
centred on pain relief - but disease-modifying 
anti-rheumatic drugs (DMARDs) and targeted 
biological agents now provide powerful disease 
suppression. These days, therefore, the 
management of RA addresses both the symptoms 
and the underlying disease process. 

Drug therapy 

Four main types of drugs are used to treat RA: 1 

• non-steroidal anti-inflammatory drugs 

disease-modifying anti-rheumatic drugs 

Simple analgesics such as paracetamol rarely 
offer enough pain relief to be used as 
monotherapy but can be a valuable adjunct to 
combination therapy with more powerful opioid 
analgesics such as codeine or tramadol. NSAIDs, 
including over the counter options, are widely used 
to relieve day-to-day pain and stiffness. 

DMARDs target the underlying disease processes 
in RA and are the lynchpin of current treatment. 
They are not painkillers and can take weeks or even 
months to show an effect. DMARDs improve 
symptoms by dampening down the inflammatory 
immune activity in the joints and, if taken early 
enough, can reduce long-term joint and bone 
damage and improve functional outcomes. 

Key DMARDs include: 

methotrexate, an antimetabolite that inhibits 
the metabolism of folic acid, is usually the first 
choice DMARD for RA 

sulfasalazine is also used to treat inflammatory 
bowel disease and is often prescribed in 
combination regimens with methotrexate or 
other DMARDs 

gold is usually given as deep intramuscular 
injections of sodium aurothiomalate, which 
accumulates slowly in the body and reduces 

penicillamine is a metabolite of pencillin that 
exerts immunosuppressive effects 

hydroxychloroquine, an antimalarial drug, is 
usually prescribed for RA where inflammatory 
activity is moderate. 

Other disease-modifiers such as azathioprine, 
ciclosporin, cyclophosphamide and leflunomide 
are considered more toxic and generally reserved 
for cases that have not responded to other 
DMARDs. 2 

The so-called 'biologies' are specifically designed 
to target aberrant cytokine responses seen in RA. 
These drugs effectively inhibit TNF-alpha - a pro- 
inflammatory mediator that has been pinpointed 
as one of the major molecules involved in the 
pathogenesis of RA and a key culprit in joint damage. 
To be eligible, patients must have active RA that 
has failed to respond to, or tolerate, standard 
DMARD treatment, including methotrexate. 

Concerns and contraindications 

Analgesics and NSAIDs 

• Paracetamol has a sound safety profile with a 
low risk of side effects, no significant drug 
interactions (apart from warfarin) and is suitable 
for use in most concomitant conditions. 

Caution should be exercised when giving NSAIDs 
to elderly patients and those with allergic 
disorders, coagulation defects, renal, cardiac or 
hepatic impairment, and asthma. Use Cox-2s with 
caution where there is a history of cardiac failure, 
left ventricular dysfunction, hypertension, oedema 
or risk factors for heart disease. 

All NSAIDs are contraindicated in severe heart 
failure. Conventional NSAIDs are also 
contraindicated in patients with previous or active 
peptic ulcers. Cox-2s must not be given to patients 
with ischaemic heart disease, cerebrovascular 
disease, peripheral arterial disease, moderate or 
severe heart failure or active ulceration. 

• The main side effects of NSAIDs include gastro- 
intestinal disturbances, nausea, diarrhoea, Gl 
bleeding and ulceration, and potential 
hypersensitivity reactions. 

NSAIDs also have a range of interactions, which 
are listed in the BNF. 

Methotrexate 2,3 can affect blood count (via 
bone marrow suppression) and cause liver cirrhosis 
(even at low doses) and pulmonary toxicity. 
Regular monitoring is needed throughout 
treatment and patients should be counselled to 
report all signs and symptoms suggestive of 
infection - especially sore throat. 

Methotrexate should be used with caution in 
patients with blood disorders, peptic ulceration, 
ulcerative colitis, diarrhoea and ulcerative 
stomatitis, pleural effusion or ascites, and acute 

Methotrexate is contraindicated in active 
infection and immunodeficiency syndromes, 
hepatic and severe renal impairment, liver disease, 
pregnancy and breastfeeding. 

Aspirin and other NSAIDs reduce methotrexate 
excretion, so careful dose monitoring of the latter 

16 Chemist J Druggist 10.07.10 


not relieved by paracetamol, ibuprofen or a 

Can cause addiction. Use ler 3 dais only. 


Product Information: Solpadeine Max Soluble Tablets. Presentation: Paracetamol 500 mg, Codeine Phosphate Hemihydrate 12.8 mg and Caffeine 30 mg. Uses: Short term treatment 
of acute moderate pain not relieved by paracetamol, ibuprofen or aspirin alone. Dosage and administration: Dissolve in water before taking. Adults and children 12 years and over Two 
tablets up to four times daily. Not more than 8 tablets in 24 hours. Children under 12 years: Not recommended. Do not take for more than 3 days without consulting a doctor 
Contraindications: Known hypersensitivity to ingredients. Precautions: Can cause addiction. Use for 3 days only. Renal or hepatic impairment, non-cirrhotic alcoholic liver disease Salt 
restricted diet. Sufferers from persistent headache and withdrawal symptoms should consult a doctor. Interactions: Warfarin or other coumarin anticoagulants, domperidone metoclopramide 
.olestyramme, monoamine-oxidase inhibitors, mexiletene. Pregnancy/lactation: Do not use without medical advice. Side effects: Paracetamol: rarely, hypersensitivity including skin raslr 
>ery rarely, reports of blood dyscrasias (not necessarily causally related). Codeine: constipation, nausea, vomiting, vertigo, difficulty with micturation, dry mouth rashes urticaria dizziness' 

rowsiness, restlessness and irritability. Legal category: P. Product licence number: 00071/0234. Product licence holder: GlaxoSmithKline Consumer Healthcare, Brentford TW8 9GS 
O.K. Package quantity and RSP: 16s £3.49, 32s £5.89 Date of last revision: January 2010. Solpadeine is a registered trade mark of the GlaxoSmithKline group of companies. 

Source: Neilsen: Total Chemists MAT Value & Unit Sales (11 .12.09) 





18 Rheumatoid arthritis: pt 2 ^ 20 Cannabis addiction ^ 22 Weight management ^ 25 Sickness rights 

is needed if these medicines are used together. 
Patients on methotrexate should avoid self- 
medication with OTC aspirin, ibuprofen or 
diclofenac. Methotrexate also interacts with a 
range of drugs - see the BNF for the full list. 
Interaction with alcohol raises the risk of liver 
damage so intake should be limited or avoided 
while on methotrexate. 

Because methotrexate is teratogenic, effective 
contraception is required in both men and women 
during treatment, and for a further three months. 

• The most common side effects of methotrexate 
are rash, itching, photosensitivity, mouth ulcers, 
chest pain, breathing problems, nausea, vomiting, 
diarrhoea, headaches, drowsiness and blurred 
vision. Folic acid, which is often co-prescribed with 
methotrexate, can reduce the severity of side effects. 

Sulfasalazine 2,3 should be used with caution in 
patients with a history of allergy or asthma, G6PD 
deficiency, slow acetylator status, acute porphyria, 
renal and hepatic impairment, pregnancy and 
breast-feeding. It is contraindicated in sulphonamide 
hypersensitivity and severe renal impairment. 

Side effects include rashes, gastrointestinal 
intolerance and occasional leucopenia, 
neutropenia and thrombocytopenia. Close 
monitoring of full blood counts is necessary until 
therapy is stabilised. 

Possible drug interactions are digoxin, folic acid, 
azathioprine and mercaptopurine. 

Good fluid intake is essential while on 
sulfasalazine - patients should be encouraged to 
drink six to eight glasses of water a day. 
Sodium aurothiomalate 

• Gold 2 is contraindicated in people with a history 
of blood disorders or bone marrow aplasia, 
exfoliative dermatitis, lupus, necrotising 
enterocolitis, pulmonary fibrosis, severe kidney and 
liver dysfunction and acute porphyria. Caution 
should also be applied in mild-to-moderate 
hepatic and renal impairment, pregnancy and 
breastfeeding, elderly patients and those with a 
history of urticaria, eczema or colitis. 

Side effects of gold include severe anaphylactic 
reactions, stomatitis, taste disturbances, colitis, 
hepatotoxicity with cholestatic jaundice, 
pulmonary fibrosis, peripheral neuropathy, mouth 
ulcers, proteinuria, blood disorders, nephrotic 
syndrome, gold deposits in the eye, alopecia and 
skin reactions. 

Gold interacts with penicillamine. 

Penicillamine 2,3 should be used cautiously in 
renal impairment, pregnancy and breastfeeding 
and in patients receiving concomitant nephrotoxic 
drugs or gold. Regular blood counts and urine tests 
are needed. Penicillamine is expressly contra- 
indicated in lupus. 

Common side effects include nausea and 
vomiting, loss of appetite, loss of taste and rash. 

• Penicillamine interacts with antacids, clozapine, 
digoxin, gold, iron, NSAIDs and zinc. 

• Caution should be exercised in patients with 
neurological disorders (especially epilepsy), severe 
gastrointestinal problems, G6PD deficiency, 
moderate-to-severe hepatic impairment, 
pregnancy, acute porphyria and in the elderly. 
Hydroxychloroquine ,3 may exacerbate psoriasis 
and aggravate myasthenia gravis. Regular 

ophthalmological check-ups are recommended 
because of the potential (albeit rare) risk of 
retinopathy. More common side effects include 
upset stomach, headache, skin rashes and itching, 
o Concurrent use of hepatotoxic drugs should be 
avoided. There are also significant interactions with 
other drugs - see the BNF for a full list. 

Mice guidelines 

Nice 4 advises that intervention in RA should be 
early and efficacious. This aggressive approach to 
pharmacotherapy is based on clear clinical 
evidence showing a 'window of opportunity' for 
preventing inflammation-induced structural 
damage to joints. In newly-diagnosed active RA, 
DMARD combination therapy is recommended as 
first-line treatment - to be started as soon as 
possible and preferably within three months of 
the onset of persistent symptoms. This should 
include methotrexate and at least one other 
DMARD, plus short-term glucocorticoids. Once 
the disease is stable, doses can be cautiously 
reduced to levels that maintain disease control, 
but with re-escalation at the first sign of flare. 

When introducing drugs to boost disease control, 
it may be possible to decrease or stop pre-existing 
medication if the new therapy is successful. 
However, prompt review is needed whenever 
DMARD or biologic doses are decreased or stopped. 
For new patients in whom DMARD combination 
therapy is not appropriate, Nice advises starting 
with monotherapy and concentrating on fast 
escalation to a clinically effective dose. 

The TNF-alpha inhibitors adalimumab, 
etanercept, infliximab and certolizumab pegol are 
options for active RA that has failed to respond to 
at least two DMARDs, including methotrexate 
(unless contraindicated) 2 Biologies should ideally 
be given in combination with methotrexate; 
however, when methotrexate cannot be used 
because of intolerance or contraindications, 
adalimumab or etanercept can be given as 
monotherapy. 2 Anakinra, another biologic cytokine 
modulator, is licensed for RA but not 
recommended by Nice for routine treatment. 

Nice has recently published a new draft 
guideline that changes its stance on refractory RA. 
Although previously rejected on cost grounds, 
tocilizumab is now recommended in combination 
with methotrexate in moderate to severe active 
RA and can be used in patients whose disease has 
responded inadequately to one or more TNF-alpha 
inhibitors and rituximab (or in whom rituximab is 
contraindicated or withdrawn due to adverse 
effects). Nice has also lifted earlier restrictions on 
anti-TNF use. Patients who fail to respond (or stop 
responding) to a first TNF-alpha inhibitor will now 
have the option of trying a second anti-TNF agent. 
(See individual Nice guidelines on each biologic for 
specific details of their place in therapy.) 

Nice suggests symptom control with analgesics 
should be offered to all patients with inadequate 

pain control. Standard NSAIDs or Cox-2s are to be 
offered as first choice, co-prescribed with a proton 
pump inhibitor and given at the lowest effective 
dose for the shortest possible time. Because of the 
potential gastrointestinal, liver and cardiorenal 
toxicity with NSAIDs and Cox-2 inhibitors, it is 
important to: 

: consider individual patient risk factors, including 

age, when choosing drug and dose 

■ assess and/or monitor patient risk factors 

• consider other analgesics if the patient is already 
taking low-dose aspirin for other conditions. 

In cases where analgesics fail to offer satisfactory 
symptom control, the DMARD or biologic regimen 
should be re-examined. Glucocorticoids can be 
useful short-term treatment for flares or as an 
additional element to DMARD combination 
therapy. However, their long-term use in 
established RA is restricted to cases where all other 
treatments have been tried, and providing 
complications have been fully discussed. 

Nice stresses the importance of co-ordinating 
RA management within a multidisciplinary 
healthcare team in order to maximise outcomes 
for patients. 

Self help 

Self care is a key element to overall RA 
management, with a focus on protecting and 
preserving joint function. To this end, patients 
should be advised to: 
balance rest and exercise 

• avoid contact sports and high impact activities - 
swimming is one of the best activities for RA 

• wear exercise shoes with thick soles to help 
absorb shocks 

© protect joints from unnecessary strain. Joint- 
sparing techniques can be found on the Arthritis 
Research UK website 

• keep weight under control. 

Nice insists there is no strong evidence dietary 
changes can benefit patients. 4 However, a 
Mediterranean-style diet is to be encouraged on 
the basis of its low saturated fat content and high 
intake of healthy unsaturated fats such as fish 
oils. 4 In a recent scientific review of anti-arthritis 
supplements, fish body oils were given the top 
efficacy rating of 5 out of 5 based on good 
evidence supporting their ability to reduce RA 
symptoms. 5 There is also some evidence that 
combined treatment with fish body and liver oils 
may be of long-term benefit, allowing the daily 
requirement for NSAIDs to be reduced. 5 
References are available in the full version of this 
article at 
Helen Boreham is a freelance medical writer 
with an MSci in medicinal chemistry. 

Download a CPD log sheet that helps you 
complete your CPD entry when you 
successfully complete the 5 Minute Test for 
this Update article online (p20). 


Update looks at pain control 
in palliative care 

18 Chemist Druggist 10.07.10 

Weight loss benefits 
beyond what the 
eye can see 

alii is the only non-prescription 
weight loss medicine licensed 
throughout Europe. A new 
three-month study* has shown 
that alii, when used with a 
reduced calorie, lower-fat diet, 
not only significantly reduces 
total bodyweight but also 
harmful excess visceral fat' 
that can contribute to diabetes 
and heart disease 2 

Help customers understand the 
meaning of healthy weight loss. 
Talk to them about visceral fat 
and positive change with alii. 

alii is for overweight adults with BMI > 28 kg/rrf 

Open-label 3-month study in 24 individuals with BMI > 28 kg/m- 
and increased waist circumference. Visceral fat measured at 
baseline and endpoint 


60 mg hard capsules 

Positive change from 
the inside out 

Product Information, alii 60 mg haid capsules (orlistat) 
Indication Weight loss in adults BMI > 28 Dosage Adults 
(18 or over) One capsule within an hour of each of three 
main meals Max, 3 caps/day for up to 6 months Use with 
lower fat mildly hypocaloric diet. It no weight loss within 
12 weeks refer to HCR Diet and exercise should start prior to 
treatment Contraindications Hypersensitivity to ingredients; concurrent 
treatment with oral anticoagulants or ciclosporin, chronic malabsorption syndrome; cholestasis, 
pregnancy, breast-feeding Special warnings and precautions See GP if kidney disease, on 
amiodarone. levothyroxine or medication for diabetes or epilepsy. See HCP if on medication for 
hypertension or hypercholesterolemia'. Risk of Gl symptoms increases with fat consumption. 
Take multivitamin at bedtime. See GP if rectal bleeding. Oral contraceptive efficacy may be 
reduced if severe diarrhoea; use additional contraception. Drug interactions' Ciclosporin, oral 

anticoagulants, levothyroxine, antiepileptics, fat soluble vitamins, acarbose, amiodarone Pregnancy 
and lactation Do not use during pregnancy or lactation Side effects See SPC for full details 
Predominantly gastrointestinal eg oily stools, urgency; usually mild and transient, risk reduced 
by low fat consumption Pancreatitis, oxalate nephropathy, hepatitis, cholelithiasis, abnormal liver 
enzymes, anxiety, hypersensitivity reactions including anaphylaxis, bronchospasm, angioedema, 
pruritus, rash, and urticaria, bullous eruption Legal category P Marketing Authorisation 
Holder Glaxo Group Limited. Greenford. Middlesex, UB6 OMN MA Number EU/i/07/401/007 009 
& Oil Pack size and RSP (excl. VAT) 42s £2865. 84s £4343. 120s £5102 Last revised April 2010 
References 1 GSK data on file 2010 (visceral fat 
studyl) 2 World Health Organisation Thechallenge 

of obesity in the WHO European region and the ffll (X& MyPhar - mAssi „ c0 uk 

e 2007 Available at www.euro p 1 **^'™ 1 ™ 1 ;™ 
whoint/clocument/E89858pdf Accessed 14/1/10 

alii is a registered trademark of the GlaxoSmithKline group of companie: 






^ 18 Rheumatoid arthritis: pt 2 ▼ 20 Cannabis addiction ^ 22 Weight management ^ 25 Sickness rights 

d arthritis: part 2 

What are the side effects of methotrexate? Why should 
patients taking hydroxychloroquine have regular eye 
check ups? What does Nice recommend for the 
treatment of RA in a newly diagnosed patient? 

This article describes the management of rheumatoid 
arthritis and the drug therapy used. There is information 
about analgesics, NSAIDs, DMARDs and corticosteroids, 
how they work, side effects and contraindications. The 
Nice guidelines and self help are also discussed. 

Update your knowledge of the Nice guidelines for the 
management of rheumatoid arthritis in adults at 

a Find out more information about DMARDs from the 
Patient UK website at 

© More information about the prescribing of drugs for 
RA can be found in section 10.1.3 in the BNF. 

» Think about the advice you could give about RA 
medication in an MUR. What lifestyle advice could you 
give? The National Rheumatoid Arthritis Society has a 
list of tips for sufferers at 
rheumatoid6 that your patients may find useful. 

Are you now familiar with the management of RA? Are 
you confident in your knowledge of the side effects and 
contraindications of the drugs used? Could you give 
lifestyle advise to RA patients? 

C minute test 

mJ What have you learned? 

Test yourself in three easy steps: 

Step 1 

Register for Update 2010 and receive a unique PIN number 

Step 2 

Access the 5 Minute Test questions on the C+D website at 

Step 3 

Use your PIN to complete the assessment online. Your test score will be 
recorded. If you successfully complete the 5 Minute Test online, you will 
be able to download a CPD log sheet that helps you complete your CPD 

Registering for Update 2010 costs £37.60 (inc VAT) and can be done easily 
at or by calling 0207 921 8425. 

Signing up also ensures that C+D's weekly Update article is delivered 
directly to your inbox free every week with C+D's email newsletter. 

Get a CPD log sheet for your portfolio when you successfully complete 
the 5 Minute Test online. 

How do you recognise cannabis addiction? 

At home one evening David Spencer, 
pharmacist at the Update Pharmacy, 
gets a telephone call from his friend 
Barry, who sounds worried. 

Barry says: "David, do you know 
how to tell if someone is using 

"Can I ask why you want to 
know?" replies David. 

"It's my son, Simon. You know 
we've had some problems with him. 
He dropped out of college, hasn't got 
a job, doesn't seem to have many 

friends and spends most of his time 
loafing about at home." 

"So, what makes you think he 
might be using cannabis?" 

"Firstly, it's the smell in his room. 
I'm pretty sure that he's been 
smoking in there but it doesn't smell 
like cigarettes. On top of that, he 
never was what you would call a 
lively boy, but he seems to have 
become even more lethargic lately. 
And he's always short of money and 
asking me for some, although he 
rarely goes out and I can't see what 
he could be spending it on. I don't 
know whether this has anything to 
do with it, but his eyes look red and 
bloodshot, too." 

"I'm no expert," David replies, "but 
I think your suspicions could be right. 
If you want, I can put you in touch 
with some agencies that could either 
confirm or dispel your fears, and if 
he's addicted they could help him to 
get off it." 

"I'd rather keep it in the family," 
Barry says. "I was hoping you might 
know how I should deal with it." 

1. Could the signs Barry has listed 
indicate cannabis use? 

2. What other tell-tale signs are 
there in young people? 

3. What are the acute adverse 
effects of cannabis use? 

4. What are the long-term 

5. What advice on the 
management of withdrawal could 
David give Barry for his son? 

6. Are there any medicinal 
products containing cannabis 
licensed for use in the UK? 

1. Yes. 

2. Attempts to mask the smell of 
cannabis smoke with air freshener or 
incense; small burns on the thumb 
and forefinger; signs of depression or 
isolation; withdrawal from family 
activities; sudden drop in academic 
performance; abandoning previous 
activities and interests, eg sports, 
hobbies; appearing confused, slow 
and lethargic. 

3. Anxiety, confusion, drowsiness, 
panic reactions, psychosis, 
hallucinations, psychomotor 
impairment; red eyes; memory loss; 
tachycardia, palpitations, postural 
hypotension, flushing; coughing, 
sore throat, bronchospasm (in 

asthma sufferers); abdominal pain, 
nausea, vomiting. 

4. Bronchitis, possibly lung cancer; 
oligospermia, gynaecomastia, 
reduced libido; insomnia, depression, 
anxiety, decreased cognitive 
function, possibly schizophrenia. 

5. Reduce use gradually before 
cessation; delay first use of cannabis 
until later in the day; advise on good 
sleep hygiene, including avoidance 
of caffeine, which may exacerbate 
irritability, restlessness and 
insomnia; try relaxation, progressive 
muscular relaxation and distraction. 

6. Yes, Sativex, an oral spray 
containing Cannabis sativa extract 
used for the treatment of muscle 
stiffness in multiple sclerosis. It is 
now officially licensed in the UK, but 
has been available for several years 
on an open general licence from the 
Home Office, allowing it to be 
prescribed and dispensed on a 
named patient basis. 


Winstock AR, Witton J. Assessment 
and management of cannabis use 
disorders in primary care. BMJ 2010; 


Abbreviated Prescribing Information - Zarzio- Filgrastim. Presentation: 30 MU/0.5 ml and 
48 MU/0.5 ml solution for injection or infusion in pre-hlled syringe Uses: Reduction in the duration 
of neutropenia and the incidence of febrile neutropenia in patients treated with established cytotoxic 
chemotherapy for malignancy (with the exception of chronic myeloid leukaemia and myelodysplastic 
syndromes) and reduction in the duration of neutropenia in patients undergoing myeloablalive 
therapy followed by bone marrow transplantation considered to be at increased risk of prolonged 
severe neutropenia. Mobilisation of peripheral blood progenitor cells (PBPC). In children and adults 
with severe congenital, cyclic, or idiopathic neutropenia with an absolute neutrophil count (ANC) 
of < 0.5 x 1 O'/l, and a history of severe or recurrent infections. Treatment of persistent neutropenia 
in patients with advonced HIV infection. Please refer to the Summary of Product Characteristics for 
full prescribing indications Administration: Filgrastim should only be given in collaboration with 
appropriate and experienced specialist centres with the necessary facilities. When given by infusion, 
filgrastim solution must be diluted with alucose; see Summary of Product Characteristics for details' 
Established cytotoxic .chemotherapy. Subcutaneous injection or intravenous infusion. Patients treated 
with myeloablalive iherapy followed by bone marrow transplantation: Intravenous short-term [over 
30 mins] infusion or as a subcutaneous or intravenous continuous infusion over 24 hours. 
Mobilisation of PBPC Subcutaneous injection or subcutaneous continuous infusion SCN/HIV 
infection: Subcutaneous injection. Dosage: for the approved indications the typical dosoge range 
is from 0. 1 MU/kg/day to 1 .2 MU/kg/day. For the detailed instructions on dosage, please refer 
to the SPC Contraindications: Hypersensitivity to the active substance or to any of the excipients 
Precautions Special wornings: Zarzio should not be used to increose the dose o( cytotoxic 
chemotherapy beyond established posology regimens. Should not be administered to patients with 
severe congenital neutropenia (Koslmonn's syndrome] with abnormal cytogenetics. Established 
cytotoxic chemotherapy: Malignant cell growth. Zarzio should not be administered in patients with 
myelodysplastic syndrome or chronic myelogenous leukaemia. Care should be taken to distinguish 
the diagnosis of blosl transformation of chronic myeloid leukaemia from acute myeloid leukaemia. 
Caution should be taken in patients with secondary AMI. Safety and elicacy of administration in 
it novo AMI patients < 55 years with aood cytogenetics ll(8;2 1 1, 1(1 5; 17), and inv(16|] have not 
been established, leucocytosis. White blood cell counts should be performed ol regular intervals 
during therapy. If leukocyte counts exceed 50 x 109/1 after the expected nadir, Zarzio should be 
discontinued immediately. For PBPC mobilisation Zarzio should be discontinued or reduced if the 
leukocyte counts rise to > 70 x 109/1. Risk associated with increased doses of chemotherapy 
Intensified doses of chemolherapeulic agents may lead to increased toxicities including cordiac, 
pulmonary, neurologic, and dermatologic elects (please refer to the Summory of Product 
Characteristics of the specific chemotherapy ogenls used) Regular monitoring of platelet count and 
haemalocrit is recommended Special core should be taken when administering single or 
combination chemolherapeulic ogenls which are known to cause severe thrombocytopenia. Other 
special precautions: In patients with reduced precursors, neutrophil response may be diminished (see 
SPC for details]. There have been reports of Graft versus Host Disease IGvHD) and fatalities in 
patents receiving G-CSF after allogeneic bone marrow transplantation (refer to SPC). Mobilisation 
of PBPC: Prior exposure to cytotoxic agents: After extensive myelosuppressive iherapy, larzio, may 
not show sufficient mobilisation of PBPC to achieve the recommended minimum yieltf or acceleration 
of platelet recovery [see SPC for details) Assessment of progenitor cell yields: Results of flow 
cytometric analysis of CD34+ cell numbers vary depending on the precise methodology used, 

therefore, recommendations of numbers based on studies in other laboratories need to be interpreted 
with caution Normal donors prior to allogeneic PBPC transplantation: Only to be considered in 
normal donors for the purpose ol allogeneic stem cell transplantation. Transient thrombocytopenia 
following Zarzio administration and leukapheresis has been observed (see SPC for further details] . 
Zarzio should be discontinued or the dose reduced if the leukocyte counts rise to > 70 x ]0'/l. 
Donors who receive GOSFs for PBPC mobilisation should be monitored until haematological indices 
return lo normal (see SPC for details). Transient cytogenic modifications hove been observed in 
normal donors following G-CSF use. Spleen size should be carefully monitored. A diagnosis of 
splenic rupture should be considered in donors and/or patients reporting left upper abdominal pain 
or shoulder lip pain. Recipients of allogeneic PBPCs mobilised with larzio: Immunological 
interactions between the allogeneic PBPC graft and recipient moy be associated wilh an increased 
risk of acute and chronic GvHD when compared with bone marrow transplantation. SCN: Blood cell 
counts: Platelet counts should be monitored closely, especially during the first few weeks therapy 
Consideration should be given lo intermittent cessation or decreasing the dose in patients who 
develop thrombocytopenia. Other blood cell changes occur, including anaemia and transient 
increases in myeloid progenitors, which require close monitoring of cell counts. Transformation to 
leukaemia or myelodysplastic syndrome. Special care should be taken in the diagnosis of SCNs lo 
distinguish them from other haematopoietic disorders. Complete blood cell counts with differential 
and platelet counts, and on evaluation of bone marrow morphology and karyotype should be 
performed prior to treatment. If patients with SCN develop abnormal cytogenetics, the risks and 
benefits of continuing Zarzio should be carefully weighed, Zarzio should be discontinued if MDS 
or leukaemia occurs. It is recommended to perform morphologic and cytogenetic bone marrow 
examinations in patients ol regular intervals (approx, every 1 2 months). Other speciol precautions 
Causes of transient neutropenia, such as viral infections should be excluded Splenic enlargement 
is o direct effect ol filgrastim and spleen size should be monitored regularly. Regular urine analyses 
should be performed lo monitor hoematuria/proteinuria. The safety ond efficacy in neonates and 
patients wilh autoimmune neutropenia have not been established HIV infection Blood cell counts, 
ANC should be monitored closely, especially during ihe first few weeks ol Zarzio therapy (see SPC 
for details], fisk associated wilh increased doses ol myelosuppressive medicinal products: Regulor 
monitoring of blood counts is recommended (see SPC for details]. Infections and molrgnonoes 
causing myelosuppression The effects of filgrastim on neutropenia due lo bone marrow-infiltrating 
infection or malignancy have not been well established. Other special precautions Pulmonary 
adverse reactions such os interstitial pneumonia have been rorely reported following Filgrastim, and 
patients with a recent history of pulmonary problems may be ot higher risk Monitoring of bone 
density may be indicated in patients wilh underlying osteoporotic bone diseases who undergo 
continuous iherapy wilh Zarzio for more than 6 months. Physicians should exercise caulion when 
considering ihe use of Zorzio in patients wilh sickle cell disease and carefully evaluole ihe potential 
risks ond benefits ol treatment. 
Increased haematopoietic activity of 
the bone marrow in response lo 
growth factor iheropy has been 
associated wilh Iransienl positive 
bone-imaging findings which should 
be considered when interpreting such 

results Zarzio contains sorbitol Patients with rare hereditary problems of fructose intolerance should 
nol use ihis medicinal product Interactions: Use is nol recommended in the period from 24 hours 
before lo 24 hours after myelosuppressive cytotoxic chemotherapy. Preliminary evidence from a 
smoll number of patients Ireoled concomitantly wilh filgrastim ond 5-fluorouroci! indicates that ihe 
severity of neutropenia may be exacerbated Possible interactions with other haematopoietic growth 
factors ond cytokines have nol yel been investigated in clinical studies, fithium is likely lo potentiate 
the effect of filgrastim Pregnancy ond lactation: No adequate data available. There are literature 
reports where transplacental passage hos been demonstrated Animal studies show no evidence of 
teratogenicity Zorzio should be used in pregnoncy only if the expected benefit outweighs the 
potential risk lo the fetus. Use whilst breast-feeding is nol recommended. Side effects: Serious 
Pulmonary adverse reactions (haemoptysis, pulmonary haemorrhage, pulmonary infiltrates, 
dyspnoea and hypoxia], splenic rupture, hepatomegaly, severe allergic reaction (anaphylaxis, 
ongioedema, urticaria, rash) Common Mild lo moderate musculoskeletal pain, blood alkaline 
phospholose, blood lactate dehydrogenase (LDH) increased, gammo-glulamyllransferose (GGT), 
blood uric acid increased (reversible, dose-dependent, mild or moderate), leucocytosis! 
thrombocytopenia, splenomegaly (generally asymptomatic, olso in patients), anoemia, headache, 
epislaxis, diarrhoea, cutaneous vasculitis (during long lerm use), alopecia, rash, osteoporosis, 
arthralgia, blood glucose decreosed and injection site pain. Uncommon' Hypotension, spleen 
disorder, rheumoloid arlhrilis and arthritic symptoms exacerbation, aspartate aminotransferase 
(AST) and blood uric ocid increased (transient, minor), hoemaruno and proteinuria. Sore Vascular 
disorders including venoocclusive disease ond fluid volume disturbances Very rare Pulmonary 
oedema, interstitial pneumonia, pulmonary infiltrates, Sweel's Syndrome, cutaneous vasculitis, 
Micturition disorders (predominantly drama], Haemoptysis, pulmonary hoemorrhage, pulmonary 
infiltrates, dyspnoea ond hypoxia Pock sizes/cost: (excl VAT): Bolh strengths ore available in pocks 
ol 5: 30 MU/0.5 ml: £295 .00 ond 48 MU/0 5 ml. £470 .00. Legal Category: POM MA Holder: 
Sandoz GmbH, Biochemiestr 1 0, A-6250 Kundl, Austria Local representative: Sondoz [id, Frimley 
Business Park, Comberley, Surrey, GUI 6 7SR MA No. Zorzio 30 MU/0 5ml x 5 pre-filled 
syringes: EU/ 1/08/495/003. Zarzio 48 MU/0.5ml x 5 pre-filled syringes EU/ 1/08/495/007 
Last revision of text: July 20 1 Refer lo Summary of Product Characteristics lor further information 
before prescribing EU/ 1/08/495/ 1 -8001 v4 

Adverse events should be reported. Reporting forms ond Information can 
be found ot Adverse events should also be 
reported to Sandoz Ltd, 01420 478301 or 

Dale of Preparation: July 2010 EU/l/08/495/l-8.010v2 



Effectively raises neutrophils to therapeutic level: 




4 16 Rheumatoid arthritis: pt 2 ^20 Cannabis addiction W 22 Weight management ► 25 Sickness rights 

Diary of a we management service: part 1 

Weight management is a key service opportunity for community pharmacy if the sector is to 
embrace its clinical role and help patients lead healthier lives. Pharmacy-led schemes have 
already received backing from organisations such as the National Obesity Forum, but 
nationally the service is still in its infancy. To help inspire and plan your own programme, C+D 
is following two sets of pharmacists and patients to show you how a service really works in 
practice. Follow their progress at 

Weight expectations 

All pharmacies have some patients who would benefit from losing weight. 
C+D is following two pharmacies offering rather different programmes to find 
out how you can best go about helping them. Zoe Smeaton reports 

The programme 

The Asda Pharmacy weight management plan is 
based on patients adopting a healthy lifestyle - 
so exercising more and eating healthy meals 
that are low in fat. One tactic used by many 
patients is keeping a food diary and pharmacists 
can offer help with this and with looking at and 
learning from it throughout the process. 
Pharmacists also discuss motivational tactics 
with patients as they go along to help them stick 
to their programme. 

Patients can expect to lose weight gradually 
and if they manage to keep up the lifestyle 
changes this should stay off. It will also improve 
their general health and wellbeing. 

Meet the pharmacist 

Ruksana Choudhury, 
Asda Pharmacy, 

The idea to run a weight 
programme came about 
after I attended a 
course on general health and cardiovascular risk. 
The course suggested pharmacists could offer 
such programmes and we decided we'd like to give 
it a go. 

Unfortunately we weren't able to secure any 
local funding for a programme, but with Asda's 
support we decided to go ahead and run a pilot to 
get experience in setting up and running the 
service. We contacted the PCT and were able to 
obtain leaflets on topics like healthy eating and 
exercise to give to patients. Next we started trying 
to find staff members with BMIs above 25 who 
could take part in our scheme. Denise Laidlaw was 
one of the patients who enrolled. 

In the initial discussions with patients I take 
about 20 to 30 minutes, measuring their BMI and 

explaining the results to them. I also discuss their 
eating habits and physical activity levels and I 
explain how these could be improved. 

I focus on why they are there and I try to learn 
whether they really want to lose weight - I need 
to find out if they are really motivated to lose 
some weight. I don't try to persuade people to do 
it if they don't want to, but most people are quite 
interested when you talk about how it might 
improve their health. I then talk to them about 
how they might lose weight. 

This is Denise 's second time around on my 
programme - she initially lost weight but now 
feels she would benefit from a booster to lose 
some before her holiday. 

Meet the patient 

Denise Laidlaw 
(pharmacy manager) 

Following a training 
course, some of my 
pharmacists were quite 
keen to offer a weight 
programme for patients. As pharmacy manager, I 
looked into funding and when it became clear 
there wasn't any available I decided to go ahead 
anyway so the pharmacists could get some 
experience. Hopefully if funding does become 
available later this will stand us in good stead to 
bid for any services. 

All of this coincided with some news at home. 
My husband was diagnosed with type 2 diabetes 
and his doctor said if he didn't do something 
to alter his lifestyle then he might end up on 
insulin, which was a big shock for us. He wanted 
to make changes and I decided I would join him 
as I thought I could also do with losing some 
weight myself. 

When I thought about it I realised that I'd been 
giving my patients advice about cardiovascular 
disease and healthy living for years but not doing 
any of it myself. I'd never really considered it 
before, but now I had this incentive I knew I 

wanted to change my lifestyle completely. 

I think it was easier for me to adopt a healthy 
lifestyle because I already had the background 
knowledge about the role of physical activity and 
things like that. And this programme is very much 
designed around the patients themselves making 
lifestyle choices. 

The first time around working with my 
pharmacist I lost just short of three stone. I do eat 
a healthy diet now anyway, but I'm going on 
holiday this year and would like to lose some 
more weight in time for that. I'm keen to start 
seeing the pharmacist again as I'd like some 
support to help me do that. 



The programme 

The Celebrity Slim programme is a partial meal 
replacement plan in which patients replace two 
meals a day with a shake, soup or bar and eat one 
carbohydrate-free, but balanced, meal. All 
carbohydrates included in the programme are 
contained in the meal replacement products. 
Participants are also allowed three snacks a day, 
which should be healthy, for example fruit or 
natural yoghurt. 

Most people stay on the plan for eight to 12 
weeks. Patients are encouraged to eat healthily 
afterwards - the "maintenance phase" - and 
educated on how to do this, such as by 
considering factors such as the glycaemic index 
of food. 

Meet the pharmacist 

Edward Scarisbrick, 
Rowlands Pharmacy, f 
Newton Le Willows 

When Rowlands 
launched the Celebrity 
Slim programme it 
provided full training for 

22 Chemist Druggist 10.07.10 


CPD Reflect • Plan • Act • Evaluate 

Tips for your CPD entry on weight 

REFLECT Could your patients benefit from a 
weight management programme? 

PLAN Think about how you could set up 
the service. 

ACT Talk to the pharmacy manager or 

owner about your plan and involve 
staff in launching a scheme. 

EVALUATE Has the scheme improved your 
skills as a pharmacist and helped 
your patients? 

Get CPD resources straight to your inbox 

me and my staff, presenting the evidence backing 
the diet and covering topics such as patient FAQs 
and how we should answer them. 

I wondered if this was just a fad diet and 
whether people would put weight back on a few 
months later or if there were associated health 
risks. So I decided to try it myself. I lost eight 
pounds in my first week and I really didn't find it 
was any effort to follow the plan. I was eating 
regularly so I didn't feel hungry, and I became 
aware of just how much carbohydrate I used 
to eat. 

Following the diet myself has really helped me 
with the service. For one thing I actually had 
customers coming in saying: "Gosh, have you lost 
weight?" and commenting on how well I looked. I 
was then able to tell them how I'd done it and 
show them the product and some of them were 
interested in trying the diet themselves. 

But I'm also able to talk about my experience if 
they have any questions or difficulties and it can 
help motivate them to see that I've been through 
it and have succeeded. 

During the first consultation I measure the 
patient's BMI and then show them on a chart 
where they are relative to the ideal weight. 
Patients quite like that because it's a visual aid - 
they can see where they are now, and then where 
their target is. 

Starting the diet has to be their decision, and 
you don't want to nag them, but you also need to 
make it clear that the door is open for them to 
come in with questions anytime. 

Meet the patient 

Mary Ditchfield 

I want and need to lose 
two stone in weight I've 
put weight on over the 
last few years, possibly 
because I have an 
underactive thyroid. 

Losing so much weight seems like a mammoth 
task to me, especially as other diets have not been 
successful - it is a known fact that my thyroid 
makes weight difficult to lose and that I'll lose 
weight at about half the rate of people with a fully 
functioning thyroid 

I heard about the Celebrity Slim diet but I felt 
nervous about going into the shop. I wondered if I 
really wanted to do it as I thought I'd be hungry all 
the time. But I spoke to the pharmacist and he 
talked me through the process and told me about 
his own experiences losing weight on the diet. 

I like that I could lose weight quite quickly, and 
that I don't have to be weighed in front of other 
f dieters who tut if I don't lose weight. 

I find the shakes tasty and filling, which is a 
surprise. And as I love fruit it's easy to have this as 
a snack, although on one or two days of my first 
week I didn't feel hungry and only realised I had 
not had a snack when it was time for my next 
shake. I also feel I have much more energy. 

No alcohol this week and my exercise was 
Pilates twice and lots of gardening 

Find out how Ms Ditchfield and Ms 
Laidlaw are getting along on C+D's 
weekly weight management blogs 

We're stepping forward... Im 


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1 16 Rheumatoid arthritis: pt 2 1 20 Cannabis addiction 


22 Weight management 25 Sickness rights 


Your rights when you're ill 

What you need to know about absence from work due to sickness - Alan Massenhove explains 

Sickness in the workplace 
can cause stress for 
employer and employee 
alike. Fundamentally, to benefit 
from the statutory protection and 
entitlements the law affords if you 
are absent due to sickness or injury, 
as well as any related contractual 
benefits, you must understand and 
follow your obligations. 

Read the small print 

Firstly, you should always comply 
with any sickness absence provisions 
in your contract of employment, and 
follow any sickness absence policy 
published by your employer. Where 
the absence has been caused by 
bullying, harassment or victimisation, 
you should also follow any relevant 
policies your employer may have. 

Prove your case 

If you are absent because of sickness 
you must be able to demonstrate 
that you are genuinely unfit for work. 
Any absence that is not genuine is 
kely to amount to misconduct, and 
could result in disciplinary action. 

Since April 6 it is now possible to 
request from your GP and provide to 
your employer a 'statement of 
fitness for work', or 'fit note'. A fit 
note amounts to evidence of 
incapacity for statutory sick pay 
(SSP) purposes, and in most cases 
should also suffice for contractual 
sick pay purposes. 

Contracts of employment often 
provide employers with a right to 
require the employee to attend a 
medical examination. When 
requesting a medical report your 
employer must comply with the 
Access to Medical Reports Act 
1988, which requires them to inform 
you of your legal rights in a 
3rescribed form. 

Claim your sick pay 

mployers are generally under no 
statutory obligation to pay 

mployees who are absent from 
work on account of sickness. Instead, 
employers need only pay SSP. But 
f your terms and conditions of 

mployment include provision for 
ontractual sick pay, then the 
'mployer must act in accordance. 

The SSP scheme is complicated, 
md HM Revenue & Customs offers 

You must demonstrate you are genuinely unfit for work if you take time off sick 

guidance at 
ssp.htm. In summary, eligible 
employees receive no payment for 
the first three days of sickness 
absence, and thereafter they will 
receive SSP for up to 28 weeks. After 
28 weeks, employees must rely upon 
any other state benefits they may be 
entitled to. 

A condition of entitlement to SSP 
is that you must notify your 
employer of any date on which you 
are unfit for work within seven 
calendar days of that date. A failure 
to comply with this condition can 
result in SSP being withheld. 

Another condition is that you 
must produce evidence of incapacity. 
During the first seven days of absence 
your employer may only ask for 
"reasonable evidence" - typically 
self-certification. Fit notes may not 
be demanded until after this period. 
A failure to comply with this 
condition does not entitle your 
employer to withhold SSP. 

It would be a wise move to check 
your contract of employment and 
any sickness policy to establish 
whether you have any entitlement 
to contractual sick pay over and 

above SSP. Even if you have no 
express entitlement, if your employer 
has habitually paid discretionary sick 
pay in the past then there may be a 
case to argue that a contractual 
entitlement has arisen. 

Dismissal danger 

If you are absent on account of 
sickness you can be fairly dismissed 
for one or more of three reasons. 
Most dismissals will be by reason of 
your "incapability" to do the job. 
Where the absences are short term, 
intermittent and persistent, and the 
absences have a significant 
detrimental impact on your 
employer's business, then your 
dismissal may be by reason of "some 
other substantial reason". 

Unauthorised absences or failures 
to comply with sickness procedures 
may justify dismissal by reason of 
"misconduct". However, every 
dismissal must be fair and employers 
must act reasonably in treating the 
absence as a sufficient reason for 
dismissal. If facing termination, you 
should take legal advice. 
Alan Massenhove is a solicitor at 
Sykes Anderson 

CPD Reflect • Plan • Act • Evaluate 
Tips for your CPD entry on sickness absence 


Do I understand my rights and responsibilities if I or my 
staff are off work sick? 

PLAN Read this article and consider which aspects of the law arid 
m y /m Y staff's employment contracts I need to revisit. 

A ^J ^y. isit relevant sections of employment contracts. 

EVALUATE Do I know what to do if I or my staff are absent from work 
due to illness? 

Other factors 
sickness rights 


Following recent case law and 
directions from the European 
Union, statutory holiday 
continues to accrue during any 
period of sickness absence, even 
rolling over from one holiday 
year into the next. 

The rulings mean statutory 
holiday cannot be taken during 
sickness absence. If you are in 
this situation you must take the 
holiday after you have returned 
to work. If you do not return, and 
the employment is terminated, 
your employer must pay you in 
lieu of the holiday accrued but 
untaken due to the sickness. 


As a general rule, any absence 
resulting from a pregnancy- 
related illness can be treated the 
same way as any other sickness 
absence. This includes absences 
after the birth, for example for 
post-natal depression. Once 
maternity leave starts, special 
statutory maternity leave and 
pay rules will apply 


If you are on long-term sick leave 
and a member of a pension 
scheme that provides for early 
ill-health retirement, your 
employer must consider this 
option before any decision to 
dismiss is made. A failure to do 
so could result in your being able 
to claim unfair dismissal. 

Individuals who are absent from 
work because of illness may be 
protected under the Disability 
Discrimination Act 1995 (soon to 
be the Equality Act 2010). If you 
are an employee with less than 
one year of continuous service 
you may bring a discrimination 
claim if you do not qualify to 
bring an unfair dismissal claim. 

10.07.10 Chemist' Druggy 25 

Have you received your free listing? 

JOBS Call Andrew on 0207 921 8123 

C D lobs 

0207 921 8123 

Booking and copy date Contact: Andrew Walker Chemist+Druggist 

12 noon Monday prior Tel: 0207 921 8123 Ludgate House 

to Saturday publication Fax: 0207 921 8132 245 Blackfriars Road 

subject to availability London SE1 9UY 


Pharmacist Required for independent pharmacy, 

• Excellent salary 

• Private healthcare 

• Professional fees paid 

Come and join our team. 

• Relocation 

• Excellent Support 

• Surfing Lessons 

Drury's Pharmacy - 01637 872589 

CVto Liz Nickels 
1 Chester Road, Newquay, TR7 2RT 
or email 

ir IhliSh in !.l |] ;.;i:r mgpr 

!l !i :!!niey =■ [iMIIiton 

; Please contact Maria McElvenney on 
02476 432983 and email your CV to 


' Please contact Maria McElvenney on 
02476 432983 and email your CV to 

Brigg, North Lincolnshire 

Riverside Pharmacy is a surgery-based 
pharmacy in the market town of Brigg. 
It is part of a group of 3 Numark branded 
pharmacies in Brigg, Broughton and 

You will work alongside the 
Superintendent Pharmacist and receive 
excellent training in all aspects of 
pharmacy using the Numark Programme 
to prepare you for the changing, extended 
role of the future pharmacist with the 
opportunity to work with other healthcare 

To apply, please send your application 
and CV to: 


Kimberworth Park, 

Please contact Alison Hanson on 
02476 432171 or email your CV to 

Q Lloydspharmacy ^pj 

m'uu Your local health authority 



Your local health authority 


Full Time 



1. Based in Northampton. 

2. Minimum NVQ 2 Qualification. 

3. Minimum 2-3 years hospital or community experience working in a busy 

4. Experience of working with a range of PMR and labeling systems. 

5. Demonstrated commitment to ongoing career development. 

6. Excellent salary/benefits package (dependent on experience) 

If you wish to apply for the above vacancy, please send your CV to: 

Closing date for applications: 23rd July 2010 however Medco Health Solutions 
reserve the right to close early on successful applicant appointment. 

Pharmacy Manager 

v^rmon Street, 

' Please contact Alison Hanson on 
02476 432171 or email your CV to 


Tour local health authority 

Pharmacy Technicians or ACT's 

W&ni& nn* * hdlenge?\Ne are expanding our Care 
Home Pharmacy operations in London & Glasgow 

Coatbridge, ACT: Up to £25,000 pa, 

NVQ3: Up to £16,575 pa, NVQ2: Up to £12,675 pa. 

MDS experience favourable but not essential. Full Training provided. 

London WE, NVQ2: Up to £14,000 pa 

Driving Licence Essential 


37.5 hours per week, 4 weeks annual leave + Bank Holidays 
Please contact Nisha Patel on 
020 8527 1071 

or email rtisha< 

Pharmacy Manager 


Please contact Alison Hanson on 
02476 432171 or email your CV to 

I) CareHomeMeds 

Dedicated to your needs 



Applicant must be motivated, enthusiastic, 
customer friendly and hard working. 

• Minimum NVQ2/NVQ3 

• Experience Essential 

• Good Communication Skills 

Please call: Sue on 07867 523235 or email your CV to 



Your local health authority 


ACT REQUIRED for our brand new 
modern Pharmacy. 

Established Independent Pharmacy 
for many years. 

Please contact Mr. D. Rajani 07786 691810 or 

26 Chemist+Druggist 10.07.10 

Advertise your product to community pharmacy every Saturday 

Call 0207 921 81; 


0207 921 8123 

Contact: Andrew Walker 

Capital gains tax changes are 
imminent. Have you considered 
selling your pharmacy? 

Free, no obligation valuation service 

Professional guidance and management 
of the sales process to deliver the best price 
for your business 

Discounted, fixed rates on legal fees 
through our network of affiliated firms 

Established network of contacts within 
both the multiple and independent sectors 


Call today for a confidential discussion regarding the sale of your business 
on 01829 238 197 email us at 
or visit our website at 

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the legal prescription 

Cost effective specialist legal advice 
to independent retail and community 

We can assist with buying, selling, merging 
and demerging pharmacy businesses as 
well as related leases, sales and purchases 
of commercial premises 


tmmmmmmmmmmmmm solicitors 


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01543 466 660 

Are you Overstocked? 

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Check out our website - what can you 
offer us? 


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■ Takes pitlures that conforms with current Possport regulations 

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■ System extremely user fri 

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Full Kit includes: 

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IP- 1 Digital Photo Printer 
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1 60 shots of 6 identical photos 
1 60 wallets for Passport Photos 
Point of Sale 
Photo Cutter 
A6 Swing Sign 

-♦■v The 160 shots will general 

s6 ot» 0lH ° £638 40 worth of sales 
if you offer the passport 
serv ice at £3.99 

Basic Kit includes: 

FinePix S2000 HD Camera 
IP- 1 Digital Photo Printer 
Fujifilm Media Card 
120 shots of 6 identical photos 
1 20 wallets for Passport Photos 
Point of Sale 

e | — , Trie 1 2I> shots will generate 
sV S^t>"*° £478 worth of sates 
"^ai^ / if you offer the passport 
service at £3.99 

IP: £46 1. 59. J 



NET: £565 

ip : £57935 

Fujifilm FinePix Passport ID Media & Wallets NET: £3 1 .95 2 7 P. 

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te!: 01923 23 44 55 * 

fax 01923 29 88 77 • v,cb 

Is! Ju'y 2010- 3!sl July 2010 

10.07.10 Chemist -Druggist 27 


Looking to buy or sell a pharmacy? Advertise here 

Call 0207 921 8123 

C D 


business Sales 

0121 362 8880 ENGLAND & WALES or 
01324 631542 SCOTLAND 




LEASE TO BE AGREED, PRICE £275,000 plus s.a.v. 

Contact Denis O'Leary 
01206 323808 Mob 07920 476222 

E m a i I denis.olear y @p harm a cybu 




PLEASE CALL 07810 722197 OR EMAIL 


Kent T/O 

London T/O 

S.Yorkshire T/O 

E. Cumbria T/O 



If you are planning to sell your pharmacy 
you should be preparing for it now. 
Call us today for a no obligation confidential discussion: 

We can provide: - 

An up to date appraisal of the market 

A free valuation of your pharmacy 

0A comprehensive list of information and 

documents you will need to provide to buyers. 

Tips on how to achieve TOP price 

We look forward to receiving your call 

01494 722224 

" We are the only NPA ^fe I HyA 

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For further information please contact 
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We have over 900 people on our register, from all over 
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Call 07767 611774 or email: 
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Chemist+Druggist remains the clear leader 

in influencing stock decisions* 
*Linda Jones Associates Industry Survey 2009 

28 Chemist+Druggist 10.07.10 

Advertise your service to community pharmacy every Saturday 

Call 0207 921 8123 


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Got a story for Postscript? 

Charity summer bonanza - part one 

At the start of the year Postscript asked for your 
charity events - and the results have been 
staggering. So staggering, in fact, that we're not 
sure if we can squeeze everyone in. But we're 
going to have a go anyway. 

Last month Masons Chemist's four pharmacies 
teamed up to raise more than £1,500 for Cancer 
Research, when the staff joined in the 5km Race 
for Life around Loughborough University's campus. 

And the Advance Pharmacies Croup also helped 
drum up money for a worthy cause, when a team 
took on a dreaded 26-mile, three-peak challenge 
to raise £2,000 for Heart Research UK. 

Elsewhere, Midcounties Pharmacy made a 
difference to St Whites Primary School in 
Cinderford, when they donated a playground 
hamper packed full of skipping ropes and footballs 
to the school. St Whites is just one of 10 schools 
to benefit from donations from The Midcounties 
Co-operative during its Co-operative Fortnight 
charity drive. 

And speaking of skipping, all 32 branches of 
Whitworth Chemists will be hopping mad on 
July 12 as they take part in a skipathon relay on 
behalf of the British Heart Foundation. The 
pharmacies have already drummed up £6,000 
for the heart disease charity this year. 

Midcounties Pharmacy's Nick Porter and Cenna 
Bishop deliver footballs to St Whites Primary School 
in Cinderford 

C+D reader of the week 

Stephen Foster of Pierremont Pharmacy in Kent and find 
hat a man brave enough to jump out of planes wanted to 
r a living when he was little. 

If you could choose any career other than 
pharmacy, what would you pick? I wanted to be 
a professional cricketer when I was younger but I 
didn't quite make the grade. That would be my 
dream job. 

If you could change one thing about pharmacy 

what would it be? I'd change the way we're 
regarded by other healthcare professionals. I'm 
doing quite a lot of work on that at the moment, 
working with clinical leaders. 

Which service would you most like to see all 

pharmacies providing? I'm a specialist in 
respiratory conditions and allergies and I'd like to 
see pharmacies involved in early interventions for 
COPD. We do a lot of work on smoking cessation 
and we could link screening to that. 

What do you like for breakfast before a day in 
the dispensary? It's not particularly healthy, but 

there's a nice cafe near the pharmacy so I 
sometimes get bacon sandwiches for the team. 
Mine's with brown sauce every time. 

What is the scariest thing you have ever done? 

A parachute jump, especially as I had never been 
on a plane before. It was a charity jump raising 
money for the Motor Neurone Association and it 
was a fantastic experience. 

What was the last DVD you watched? Angels 
and Demons with Tom Hanks. I've read all the Dan 
Brown books and I bought it as soon as it came out. 

What should we ask the next interviewee? 

I'd like to know how they are getting involved in 
the development of the profession. 

Calling all pharmacists and technicians. We 
want you to be our reader of the week. Email 
us at 

"No dispenser should 
come to work in his 
dressing-gown and 


I have recently been perusing the latest 
edition of Dr Hermann Hager's "Technik der 
Pharmaceutischen Receptur". Now, having 
obtained permission from Dr Hager, I thought 
I should share his views. While I have 
naturally eliminated such matters as have no 
interest to English readers, these notes still 
have a certain German flavour, and will 
present ideas which have long since lost all 
novelty to readers. However, I hope at least 
some of the hints prove useful. 

Dr Hager writes: "The dispenser must 
cultivate habits of order and cleanliness. 
Dirtiness and untidiness in dress in the 
dispenser must give the public an unpleasant 
impression. Such practices as pressing corks 
with the teeth, holding powder-envelopes in 
the mouth, shaking up mixtures with the 
finger over the mouth of the bottle, breathing 
on pills to be silvered etc should be avoided. 
Decent and becoming manners are essential. 
No dispenser should come to work in his 
dressing-gown and slippers. Scolding the 
apprentice or joking with fellow-assistants are 
equally out of place; and, besides, a strict 
sense of duty towards the prescriber and 
patients must be entertained by everyone 
who would be a true pharmacist. In the 
adoption of expensive or cheap adjuncts to 
the preparation of prescriptions, such as 
covered jars, stoppered bottles and the like, 
regard should always be given to the 
circumstances of the customer." 

There is no doubt Dr Hager's concepts are 
most sensible notions that should be adopted 
by all pharmacists. 

The Victorian Pharmacist's comments 
come from a series taken from Dr Hager's 
recommendations, published by C+D in 
1884, when it was OK to give the best 
stuff only to rich customers. Have you 
ever turned up to work in a dressing gown 
and slippers? Let the Victorian Pharmacist 
know by emailing him at: 

30 Chemists-Druggist 10.07.10 

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Supporting pharmacy success 


patient care 

Pfizer commitment 
to pharmacy 

As part of a healthy partnership'" our commitment is to 
listen to you, the community healthcare experts. We want 
to understand the professional issues facing community 
pharmacy so that when we act to develop support and 
training, it meets your professional development needs, 
helping you and your pharmacy succeed. 

Our MUR workshops have proved successful and we are 
continuing to develop further "soft skills" training to help 
you counsel patients, implement pharmacy services and to 
help grow your pharmacy. 

For the most up-to-date details on our "soft skills" 
meetings please visit 

(insert code R9A8 on first page). 

Listening to pharmacy 

a healthy 

HP 0358. Date of preparation: May 201 C